University of Alexandria

Faculty of Nursing

Critical Care & Emergency Nursing

Department

Mona Saad

Assistant lecturer of Critical Care & Emergency Nursing

Critically ill patients may

present with multiple organ

involvement.

Introduction

Is an important & often under

used diagnostic indicator of

disease.

Ophthalmologic symptoms are

important to make an

appropriate diagnosis.

The eye

Eye protective barriers

The conjunctiva Tears

Blinking reflex Eyelid closure

Altered eyelid

closure

↑ Tear film

evaporation

Altered blinking

reflex

Other

medications

MV

PEEP

Tight ETT

securing tape

Altered

LOC

Muscle

relaxant

↑ Risk of eye

dryness

Serious eye complications

The potential eye

problems in ICU patients

Bacterial /

exposure keratitis

Keratitis

Chemosis “Conjunctival edema”

‘ventilator eye’Conjunctivitis

Corneal abrasionCorneal ulcers

Unfortunately…

Anticipating & preventing eye problems in

patients who may have exposure of the

cornea is not a common practice.

The exact magnitude of the problem can not be

exactly estimated

Poor documentation of eye assessment findings.

The eye care is often seen as a minor problem

which represents low priority in comparison to

other intervention specially those directed to the

management of life threatening problems.

Eye problems in ICU patients

The reported incidence rates for corneal abrasion

vary widely in the international literature.

3-60% of critically ill patients are affected with

corneal abrasion “peak incidence at 2-7 days of

ICU admission “.

Eye problems in ICU patients

A basic nursing procedure essential for all critically

ill patients .

Eye care in the ICU is often applied with

considerable variation from one health care facility to

the other.

Evidence based

practice

recommendations

for

Eye care in ICU

Assessment

Eye care

Eyelid closure

Evidence based recommendations for

eye care in ICU

Assessment of patients’ ability to maintain an

eyelid closure should be performed daily in

critically ill patients.Grade of recommendation D

Observation for iatrogenic ophthalmologic

complications should be performed at least

weekly in critically ill patients using practical

methods.Grade of recommendation D

Assessment

All ICUs should monitor the rate of iatrogenic

ophthalmologic complications.

Grade of recommendation D

Referral must be made in a timely manner for

any suspected iatrogenic ophthalmologic

complications in critically ill patients.

Grade of recommendation D

Assessment

Eye care should be part of the care provided to

all people during their admission to the ICU.

Level II.

Ointments & drops are more effective at reducing

the incidence of corneal abrasions than no eye

instillations. Level II.

Eye care

All patients who cannot achieve eyelid closure

independently & unconscious or heavily sedated

patients should receive eye care every 2 hrs

(cleaning with saline soaked gauze & the

administration of an eye specific lubricant).Grade of recommendation C.

Eye care

Eyelid closure should be maintained in intensive

care patients who cannot maintain complete

eyelid closure. Grade of recommendation D.

If eyelid closure cannot be maintained passively

then mechanical methods should be used.

Grade of recommendation C.

Eyelid closure

Polyethylene covers

are more effective at reducing the incidence of

corneal abrasions than ointments & drops. Level II

Eyelid closure

??

?

?

??

?

?

References

Andrea P, Elliott R, Rolls K, Schacht S. Eyecare in the critically ill: clinical

practice guideline. Australian College of Critical Care Nurses 2008; 21(2):

97-109.

Mui S. Making a difference in eye care: using gladwrap in eye care of ICU

patients. Hong Kong Association of Critical Care Nurses 2003; 5(1):1-6.

Ramirez F, Ibarra S, Varon J, Tang R. The neglected eye:

ophthalmologic issues in the intensive care unit. Critical Care & shock

2008; 11:72-82.

Desalu I, Akinsola F, Adekola O, Akinbami O, Kushimo O, Adefule A.

Ocular surface disorders in intensive care unit patients in a sub-saharan

teaching hospital. The Internet Journal of Emergency and Intensive Care

Medicine 2008 ; 11 (1):1-8.