Eye care in the intensive care unit: Narrative review and meta-analysis

BACKGROUND: Patients in the intensive care unit are at increased risk of exposure keratopathy. Untreated, this may progress to microbial keratitis and visual loss. DATA SYNTHESIS: A total of 20% to 42% of patients in the intensive care unit develop exposure keratopathy. The epidemiology of this underappreciated problem is reviewed. The pathophysiology of microbial keratitis is reviewed with special attention to the multiple risk factors unique to intensive care unit patients. The clinical presentation of exposure keratopathy is reviewed with tips for recognition for the practicing clinician, including suggestions for when ophthalmologic consultation is warranted. Studies and case series of screening and prevention are reviewed in detail. Two of the most studied methods of prevention, moisture chambers and lubricating ointments, are formally compared in a meta-analysis. Eight of 113 (7.1%) patients in the moisture chamber group vs. 32 of 151 (21.2%) patients in the lubrication group developed exposure keratopathy, with a summary odds ratio of 0.208 (95% confidence interval 0.090-0.479, p < 0.001). CONCLUSION: With application of simple protocols, exposure keratopathy can be prevented, thus improving patient care in the intensive care unit.