Exposure keratopathy: Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults

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Purpose:We aimed to determine the rate of exposure keratopathy (EK) in critically ill patients, identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK.Materials and methods:We undertook a two-phase prospective cohort study in a general adult ICU with first-phase being observational and an eye care protocol was introduced in the second-phase. Daily ophthalmic assessment was carried out along with recording of various risk factors.Results:We studied 371 patients. In the first phase, the overall rate of EK was 21% but the rate in mechanically ventilated patients was 56%; χ2 (1, N = 257) = 80.8, p < 0.001. Adjusted odds ratios (AOR) for development of EK was 28.6 (8.19–43.37), 13.0 (3.16–54.38) and 1.2 (1.03–1.33) with incomplete eye closure, mechanical ventilation, and higher sequential organ failure assessment score respectively. Following the introduction of the protocol, the overall rate of EK reduced to 2.6% (3 cases); χ2 (1, N = 371) = 18.6, p < 0.001.Conclusions:EK is common in critically ill patients and a simple protocol substantially reduces the incidence of EK and is easily achieved in clinical practice.HighlightsExposure keratopathy (EK) is common, but preventable, in critically ill patientsMechanical ventilation and incomplete eye closure are the major risk factorsImplementing a simple eye care protocol substantially reduces the incidence of EKThis is easily achievable in clinical practice

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