Superficial keratopathy in intensive care unit patients

To determine the prevalence of keratopathy in a randomly selected group of hospitalized patients in the intensive care unit and to identify factors associated with an increased incidence of corneal abnormalities.

We conducted bedside examinations with a portable slit lamp on 50 randomly selected patients. Evidence of superficial keratopathy was recorded. Associated factors analyzed included Glasgow Coma Scale, period in the intensive care unit, intubation status, underlying disease, and current eye care.

Superficial keratopathy was present in 20 (40%) of the patients. Of these 20, 18 (90%) were intubated, whereas of the remaining 30 patients without corneal abnormalities, only 15 (50%) were intubated (P < .01). Fourteen (70%) of the 20 patients with corneal abnormalities had been hospitalized in the intensive care unit for 1 week or longer compared with 10 (33%) of the 30 patients without corneal abnormalities (P = .03). Twelve (60%) of the 20 patients with corneal abnormalities had Glasgow Coma Scale scores of 7 or less compared with seven (23%) of the 30 patients without corneal abnormalities (P < .03). Only one of the 20 patients with superficial keratopathy was receiving ocular lubrication.

The prevalence of corneal abnormalities in the critically ill patient reflects certain predictors of keratopathy, including the Glasgow Coma Scale, length of hospitalization, intubation, and significant metabolic derangement. More ophthalmologic attention must be given to patients in intensive care units to prevent the development of ocular disease.