An Analysis of Exposure Keratopathy Cases to Promote Changes in Eye Care Practice in Intensive Care Units

Exposure keratopathy (EK) is corneal damage from prolonged environmental exposure. If untreated, EK can lead to corneal scarring and/or blindness. Critically ill patients are at high risk. A case of EK in our intensive care unit led us to investigate the incidence of EK in our critical care units and understand the interventions needed to reduce its impact. We found 44 cases of EK over 3 years. 95% received mechanical ventilation and 32% received paralytic agents. Average time to diagnosis was 15.8 days from intensive care unit admission. More than a quarter (27%) of patients had severe EK at diagnosis, and 52% of patients had received prior eye care. EK occurred frequently in our critical care units. Many subjects did not receive prophylaxis and disease was diagnosed at a late stage. To address this, we plan a 3-pronged approach focusing on prevention, early recognition, and timely initiation of treatment.