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Exposure keratitis in comatose children
1Division of Critical Care Nursing, Children's Hospital of Wisconsin, Milwaukee 53233.
Insights
Mechanical ventilation for intracranial pressure control can cause exposure keratitis in children. This condition results from undetected incomplete eyelid closure, necessitating lubrication and eyelid taping for prevention.
Area of Science:
- Ophthalmology
- Pediatric Critical Care
- Neurology
Background:
- Mechanical ventilation is crucial for managing intracranial pressure in critically ill children.
- Sedation and paralysis are often employed to facilitate mechanical ventilation.
- Exposure keratitis is a potential complication of critical illness and prolonged immobility.
Observation:
- Four pediatric patients undergoing mechanical ventilation for intracranial pressure management developed exposure keratitis.
- The severity of keratitis varied among the affected children.
- All patients had received pancuronium for paralysis and morphine for sedation.
Findings:
- Exposure keratitis in these cases was linked to subtle, undetected incomplete eyelid closure during mechanical ventilation.
- Chronic exposure of the inferior cornea was the primary pathophysiological mechanism.
- The condition manifested despite efforts to manage intracranial pressure.
Implications:
- Frequent application of ocular lubricants is recommended to prevent corneal exposure.
- Taping the eyelids shut is a suggested preventive measure for at-risk pediatric patients.
- Early recognition and intervention are vital to mitigate the severity of exposure keratitis in ventilated children.
Abstract:
Four children developed exposure keratitis of various degrees of severity while being mechanically ventilated for control of intracranial pressure. All had been paralyzed with pancuronium and sedated with morphine to facilitate ventilation. Pathophysiology of this keratitis involves subtle and undetected incomplete eyelid closure which chronically exposes the inferior one-third of the cornea. Prevention by frequent application of ocular lubricants and taping of the eyelids is recommended.