Friday, February 21, 2014

Q: Ideally, how frequent lubricant should be applied in ICU patients, who have exposed cornea to prevent keratopathy/keratitis?

Answer: Some degree of keratopathy develops in about 60% of intubated and sedated patients. Incomplete lid closure increases the risk of corneal damage very high (70% vs. 30%). Fluid imbalance and positive pressure ventilation (Ventilator eye) may make it impossible to close eyelids completely. Lubricant should be applied ideally every two hours, particularly if any sort of cornea is exposed. Overall, literature lean more towards moist chamber application than lubricant application.
1. Imanaka H, Taenaka N, Nakamura J, et al: Ocular surface disorders in the critically ill. Anesth Analg 1997; 85:343-346
2. McHugh J, Alexander P, Kalhoro A, et al: Screening for ocular surface disease in the intensive care unit. 2008;22:1465–1468
3. Mercieca F, Suresh P, Morton A, et al: Ocular surface disease in intensive care unit patients. Eye 1999; 13:231-236
4. Koroloff N, Boots R, Lipman J, et al: A randomized controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med 2004; 6:1122-1126
5. Parkin B, Turner A, Moore E, et al: Bacterial keratitis in the critically ill. Br J Ophthalmol 1997; 12:1060-1063
6. Suresh P, Mercieca F, Morton A, et al: Eye care for the critically ill. Intensive Care Med 2000; 2:162-166

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