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Ocular Surface Disease in a PICU: Incidence and Outcomes With a Dynamic Eye Care Protocol

Angela Niemi1, Brooke E Geddie2, Surender Rajasekaran3

  • 1Michigan State University College of Human Medicine, Grand Rapids, MI.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|December 14, 2019
PubMed

Insights

Sedated pediatric intensive care patients are at risk for ocular surface disease. A standardized eye care protocol significantly reduced the incidence of corneal issues in these vulnerable children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Ophthalmology
  • Ocular Surface Disease

Background:

  • Sedated intensive care patients have impaired ocular protective mechanisms, increasing risk for ocular surface disease and potential vision loss.
  • Historically, routine eye care was limited to critically ill patients receiving neuromuscular blockade.

Purpose of the Study:

  • Determine the occurrence rate of ocular surface disease in sedated and ventilated children.
  • Identify risk factors for ocular surface disease.
  • Assess the progression of ocular injury with a routine eye care protocol.

Main Methods:

  • Prospective cohort study in a tertiary care medical-surgical Pediatric Intensive Care Unit (PICU).
  • Evaluated 479 intubated patients over 19 months, performing 1,242 corneal exams.
  • Implemented staff education and a standardized PICU eye care protocol, adjusting frequency based on ocular condition.

Main Results:

  • 15% of patients had ocular surface disease on admission; incidence rose to 32.2% during hospitalization before protocol adjustments.
  • Trauma patients and those intubated prehospital or in the ED had higher initial incidence.
  • The standardized protocol decreased overall ocular surface disease incidence to 8.6% by the last examination, preventing severe complications.

Conclusions:

  • Ocular surface disease is under-recognized in critically ill pediatric patients.
  • A standardized, dynamic eye care protocol can improve corneal health.
  • Improved corneal health may reduce injury, pain, infection, and long-term vision loss in pediatric ICU patients.
Abstract

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