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Prone Positioning Covid-19 Patients: A Double-Edged Sword-A Case Report of a Devastating Ocular Complication

Mariana Leuzinger-Dias1, Mário Lima-Fontes2, Cláudia Oliveira-Ferreira2

  • 1Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. mariana.ldias@gmail.com.

Ophthalmology and Therapy
|June 19, 2021
PubMed

Insights

Prone positioning for acute respiratory distress syndrome (ARDS) can cause severe eye injuries, including ruptured globes. This case highlights the diagnostic challenges and critical management of such sight-threatening complications in COVID-19 patients.

Area of Science:

  • Ophthalmology
  • Critical Care Medicine
  • Pulmonology

Background:

  • Prone positioning is a standard treatment for acute respiratory distress syndrome (ARDS), widely used for COVID-19 patients.
  • Ophthalmic complications are known risks of prone positioning, with eye injuries being more common than in other positions.
  • While most are treatable, severe, sight-threatening conditions can arise.

Purpose of the Study:

  • To report a unique case of a ruptured globe in a COVID-19 patient undergoing prolonged prone positioning.
  • To emphasize the diagnostic difficulties and management strategies for this severe ophthalmic complication.
  • To highlight the importance of prompt recognition and intervention in life-saving support.

Main Methods:

  • Case report of a critically ill COVID-19 patient.
  • Patient management involved prolonged prone positioning.
  • Focus on the diagnostic process and treatment of an unexpected ruptured globe.

Main Results:

  • A dramatic case of ruptured globe occurred in a COVID-19 patient during prone positioning.
  • Diagnosis and management were challenging due to the patient's critical condition.
  • Successful life-saving support was provided.

Conclusions:

  • Prolonged prone positioning in critically ill patients, including those with COVID-19, carries a risk of severe ophthalmic injury.
  • Ruptured globe is a rare but devastating complication requiring high clinical suspicion.
  • Early diagnosis and multidisciplinary management are crucial for patient outcomes.

Keywords:
COVID-19Intraocular pressureProne positionRuptured globeScleral degenerations

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