Eye Care in the Critically Ill: A National Survey and Protocol

Sedated and ventilated critically ill patients often have inadequate eyelid closure and are susceptible to developing exposure keratopathy and microbial keratitis. Preventative measures reduce the risk of complications and visual loss. A telephone survey of all intensive care units in England was performed to elucidate the measures being used and their prevalence. Of 267 units, 217 participated (81%). Of these, 130 (60%) had an eye care protocol and 143 (66%) of all participating units formally assessed eyelid closure. The presence of an eye care protocol did not improve the likelihood of a unit assessing eyelid closure, a key component of the detection of patients at risk of ophthalmic complications; 66% of units with eye care protocols assessed eyelid closure formally, compared to eyelid closure assessment occurring in 65% of units that did not employ an eye care protocol. Most units used at least two protective methods per unit, the most popular being Geliperm application and Lacrilube. Self-reported complication rates in the last year were low, but only 13% of units audited eye-related complications. To improve eye care and replace current protocols, we propose a simple protocol encouraging vigilant eyelid closure assessment, administration of preventative therapy where indicated and referral if there is any corneal opacity or continuous exposure.