Screening for ocular surface disease in the intensive care unit

Area of Science:

• Ophthalmology
• Intensive Care Medicine
• Critical Care

Background:

• Ventilated patients in the intensive care unit (ICU) are at high risk of developing exposure keratopathy.
• Exposure keratopathy can lead to bacterial keratitis, often bilateral in the ICU, with a significant risk of corneal perforation.
• Ophthalmologist examinations for all ventilated patients are logistically challenging.

Purpose of the Study:

• To evaluate the reliability of intensive care unit (ICU) staff in screening for exposure keratopathy.
• To determine if ICU doctors can accurately detect signs of ocular surface damage in sedated, ventilated patients.

Main Methods:

• A prospective study conducted in a general adult ICU.
• Junior ICU doctors performed twice-weekly examinations of ocular surface and lid position in sedated patients (>24h).
• Examinations utilized fluorescein and a pen torch with a blue filter, with results compared to an ophthalmologist's portable slit lamp assessment.

Main Results:

• ICU doctors detected exposure keratopathy in 31.3% of examinations, compared to 37.5% by the ophthalmologist.
• Sensitivity was 77.8% and specificity was 96.7% for ICU doctors detecting keratopathy.
• Keratopathy was more prevalent in patients with incomplete lid closure (70.0% vs 28.9%).

Conclusions:

• ICU staff demonstrate reasonable sensitivity and specificity in screening for exposure keratopathy.
• Regular screening by ICU staff can facilitate timely treatment of exposure keratopathy.
• This screening approach aids in the earlier identification of keratitis cases in critically ill patients.