Ocular surface disease in intensive care unit patients

Purpose To assess the prevalence and natural history of ocular surface disease in patients in an intensive care unit (ICU) and to identify any predisposing factors in order to improve eye care management protocols. Methods The eyes of all patients admitted to an ICU between February and May 1998 were examined at least weekly. The eyelid position, presence of conjunctival oedema, degree of keratopathy and sedation score were documented at every assessment. Results Twenty-six patients in an ICU were followed throughout their stay, which ranged from 3 days to 10 weeks. Eleven patients (42%) had some degree of keratopathy, which was detected in the majority in the first week of their stay. The presence of ocular surface disease was closely correlated with the degree of lagophthalmos, which in turn is closely related to the depth of sedation or paralysis. Conclusions In this first ever longitudinal study it was found that assessment of lid position in ICU patients is the single most important observation to be carried out. A management algorithm derived from this evidence is based on daily observation and selective lid taping and shows encouraging early results.