Ocular surface alterations in critically ill patients: An observational study

Background and objectives Critically ill patients in intensive care units (ICUs) are vulnerable to ocular surface disorders due to impaired protective mechanisms, mechanical ventilation, sedation, and adverse environmental conditions. This study aimed to evaluate the prevalence and pattern of ocular surface alterations in ICU patients, identify associated risk factors, and determine microbial profiles in infective kerato-conjunctivitis. Methods An observational study was conducted on patients admitted in ICU for more than 72 h. Data on demographics, systemic diagnoses, ocular examinations, including Schirmer's test for severity of dry eye, conjunctival swab cultures, and corneal status were collected and analysed. Results Of the 280 patients, with mean ICU stay of 12.6 + 5.1 days, 200 (71.4%) had corneal abnormalities. Keratitis/corneal ulcer was most common (n=88, 31.4%), followed by punctate keratopathy (n=58, 20.7%) and corneal erosion (n=54, 19.3%). Lagophthalmos (n=82, 29.3%) and severe dry eye were significantly associated with corneal pathology (P<0.001). Common pathogens included Klebsiella sp. and Staphylococcus species. Longer ICU stay and higher severity of illness correlated with increased ocular morbidity. Poor GCS scores, dry eye severity, mechanical ventilation, and conjunctival status were also significant contributors. Interpretation and conclusions This study documents the high burden of ocular surface disordersin ICU patients and emphasises the need for routine ocular assessments and structured preventive protocols. Integrating simple eye care measures can mitigate visual complications and enhance overall ICU care quality.