Clinical Study
Eye (2008) 22, 1465–1468; doi:10.1038/sj.eye.6702930; published online 24 August 2007
Screening for ocular surface disease in the intensive care unit
Part of this material has previously been published as a poster at the 2004 annual congress of the Royal College of Ophthalmologists. It has not been published in any other journal. Local ethics committee approval was granted before the study (reference 03.0116). No proprietary interests declared. No funding was received
J McHugh1, P Alexander1, A Kalhoro2 and A Ionides2
- 1Intensive Care Department, St George's Hospital, London, UK
- 2Department of Ophthalmology, Moorfields Eye Hospital at St George's Hospital, London, UK
Correspondence: J McHugh, Ophthalmology Department, Queen Mary's Hospital, Frognal Avenue, Sidcup, Kent DA14 6LT, UK. Tel: +44 20 8302 2678; Fax: +44 20 8308 3052. E-mail: jim_mchugh_@hotmail.com
Received 26 November 2006; Accepted 8 June 2007; Published online 24 August 2007.
Abstract
Purpose
Ventilated patients in the intensive care unit (ICU) often develop exposure keratopathy. This predisposes to the development of bacterial keratitis, which in ICU is often bilateral, with a high risk of perforation. As regular examinations of all ventilated patients by ophthalmologists would be impractical, the purpose of this study was to assess whether ICU staff can screen reliably for keratopathy.
Methods
A prospective study was performed in a general adult ICU. Twice each week, two junior ICU doctors examined the lid position and ocular surface of all patients who had been continuously sedated for more than 24 h, using fluorescein and a pen torch with a blue filter. An ophthalmologist performed similar examinations using a portable slit lamp.
Results
A total of 48 ocular examinations were performed in 18 patients. Exposure keratopathy was found by the ophthalmologist in 37.5% of examinations and by ICU doctors in 31.3% of examinations. ICU doctors had a sensitivity of 77.8% and a specificity of 96.7% in detecting keratopathy, when compared with the findings of the ophthalmologist. All cases missed by ICU doctors had punctate erosions of less than 5% of the corneal surface. Keratopathy was significantly commoner in patients with incomplete lid closure than in patients with closed lids (70.0 vs28.9%; two-tailed Fisher's exact test P=0.027).
Conclusions
ICU staff can perform screening examinations for exposure keratopathy with reasonable sensitivity and specificity. Regular screening by ICU staff would facilitate appropriate treatment of exposure keratopathy and promote earlier identification of cases of keratitis.
Keywords:
exposure keratopathy, critical care, screening
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