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Early detection of ocular lesions in critically ill children: Testing an ocular assessment scale
Beatriz Vilchez1, Isabel Manzanal1, Marta Marcos1
1Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain.
Insights
A new scale helps detect eye injuries in critically ill children. Identifying risk factors like lagophthalmos and hyperemia can reduce ocular lesion incidence in pediatric intensive care units.
Area of Science:
- Ophthalmology
- Pediatric Critical Care Medicine
Background:
- Limited data exists on ocular lesion incidence in critically ill children.
- Understanding associated risk factors is crucial for prevention and management.
Purpose of the Study:
- To evaluate an ocular assessment scale's utility in critically ill children.
- To identify key risk factors for ocular lesions in this vulnerable population.
Main Methods:
- Prospective observational study in a pediatric intensive care unit (PICU).
- 194 children meeting study criteria were assessed using a designed ocular lesion risk scale.
- Corneal lesions were detected via fluorescein staining and confirmed by an ophthalmologist.
Main Results:
- 76 patients underwent fluorescein staining, with 32 ocular lesions detected by staff and 26 confirmed.
- 53.6% of high-risk patients developed corneal lesions.
- Multivariate analysis linked ocular lesions to lagophthalmos, hyperemia, invasive mechanical ventilation, and inotropic support.
Conclusions:
- The developed scale effectively aids in detecting corneal lesions in critically ill children.
- Identifying specific risk factors facilitates targeted interventions to minimize ocular lesion occurrence.
Background:
There is scarcity of data on the incidence and factors associated with the occurrence of ocular lesions in critically ill children.
Aim:
Test the applicability and utility of an ocular assessment scale and to identify risk factors of ocular lesions.
Study Design:
Prospective observational study. A tertiary care medical-surgical Paediatric Intensive Care Unit. 194 children without previous ocular disease who stayed in the Paediatric Intensive Care Unit for more than 48 h. An ocular lesions risk scale was designed including risk factors lagophthalmos, eye dryness, conjunctival hyperemia, slow blinking, intubation, sedation, relaxation, face mask and hemodynamic instability. Patients were classified as high-, medium-, and low-risk patients. Corneal lesions were examined by fluorescein staining according to their risk and were confirmed by an ophthalmologist.
Results:
76 patients were examined with fluorescein staining. Thirty-two ocular lesions were detected by nursing staff, 26 confirmed by the ophthalmologist. 53.6% of the high-risk patients developed a corneal lesion. Univariate analysis revealed an association between ocular damage and all factors included in the scale, except for face mask. In the multivariate analysis, ocular lesions were associated with lagophthalmos, hyperemia, invasive mechanical ventilation and inotropic support.
Conclusions:
The scale was useful to detect corneal lesions in critically ill children. The identification of risk factors will enable the development of measures to reduce the incidence of ocular lesions.
Relevance For Clinical Practice:
A new, non-validated scale allowed staff to detect eye injuries, study this problem and improve future prevention.
