Patients in the intensive care unit are at increased risk of exposure keratopathy. Untreated, this may progress to microbial keratitis and visual loss.
A total of 20% to 42% of patients in the intensive care unit develop exposure keratopathy. The epidemiology of this underappreciated problem is reviewed. The pathophysiology of microbial keratitis is reviewed with special attention to the multiple risk factors unique to intensive care unit patients. The clinical presentation of exposure keratopathy is reviewed with tips for recognition for the practicing clinician, including suggestions for when ophthalmologic consultation is warranted. Studies and case series of screening and prevention are reviewed in detail. Two of the most studied methods of prevention, moisture chambers and lubricating ointments, are formally compared in a meta-analysis. Eight of 113 (7.1%) patients in the moisture chamber group vs. 32 of 151 (21.2%) patients in the lubrication group developed exposure keratopathy, with a summary odds ratio of 0.208 (95% confidence interval 0.090–0.479, p < 0.001).
With application of simple protocols, exposure keratopathy can be prevented, thus improving patient care in the intensive care unit.
Senior Resident (JBR), Opthalmology, Albert Einstein College of Medicine, Bronx, NY; and Assistant Professor (LAE), Albert Einstein College of Medicine, Critical Care Medicine, Montefiore Medical Center, Bronx, NY.
The work was performed at Montefiore Medical Center, Bronx, NY.
Some of the results of this trial were previously presented in abstract form: Jamie Rosenberg, MD, Lewis Eisen, MD, Rachel Bloom, BA, Jeffrey Berger, MD, John Kim, MD. Prevention of exposure keratopathy in the intensive care unit: A systematic analysis of randomized controlled trials. Invest Ophthalmol Vis Sci. 2007; 48.
The authors have not disclosed any potential conflicts of interest.
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