PREVALENCE OF OCULAR SURFACE DISORDERS IN INTENSIVE CARE UNIT PATIENTS – A CROSS SECTIONAL STUDY

*Dr. Bylappanavara Girish, Dr. Aishwarya Polisgowdar, Dr. Siddesh Kumar, Dr. Karishma Munoli, Dr. Ramanna and Dr. Shrividya

ABSTRACT

Introduction: The incidence and implications of ocular surface disorders among patients in Intensive Care Units (ICUs) are critically under-researched, despite their potential impact on patient health and recovery. The ICU patients are more vulnerable to these diseases due to lack of eye care are Corneal ulcer, Infectious Keratitis, Dry Eye Syndrome, Conjunctivitis, Exposure Keratopathy and Mebomium gland dysfunction. The study aimed to assess the prevalence, risk factors, and consequences of ocular surface disorders among patients in the Intensive Care Unit (ICU). Aim and objectives: To investigate the prevalence, risk factors, and consequences of ocular surface disorders among patients admitted to Intensive Care Units (ICU). Methodology: This cross sectional study was conducted on 140 various ICU patients admitted in Raichur institute of Medical sciences, Raichur over a period of 6 Months. Patient admitted to the ICU during the study period were selected for the study. Participants with severe ocular trauma or pre-existing ocular conditions were excluded. Convenience sampling was used. Data was collected by utilizing a combination of medical record reviews, clinical observations, direct ocular examinations with torch, schirers strips and fluroscine stain. Results: The study showed predominance of males (80) over females (60). Sedation was used in 16 participants, with a p-value of 0.01 indicating a significant relationship with ocular symptoms. Lagophthalmos, or incomplete eyelid closure, was present in 16 participants with a significant p-value of 0.01. The use of mechanical ventilation was significantly associated with ocular complications, including conjunctival hyperemia (p-value 0.01), mucopurulent discharge (p-value 0.157), and corneal staining (p-value 0.001). Conjunctival hyperemia and mucopurulent discharge were significantly correlated with longer ICU stays (p-values of 0.001 and 0.001, respectively). Schirmer's test results showed a significant association with ocular symptoms (p-values of 0.001 for both eyes). Most participants had normal tear production (>15 mm), but those with reduced tear production (0-5 mm) were more likely to experience ocular discomfort and visual symptoms. The association between ICU stay duration and ocular conditions like corneal staining (p-value 0.001) indicates that prolonged ICU stays can lead to increased ocular surface damage. Disussion: Ocular surface disorders are estimated to affect around 60% of critically ill patients. Eyelids serve as a critical barrier, protecting the ocular surface from trauma and infection. In ICU patients, sedatives and neuromuscular blockers often impair eyelid closure, with 20% to 75% experiencing incomplete closure due to inhibition of the orbicularis oculi muscle. Factors like normal tear distribution, blinking, and complete eyelid closure during sleep protect the eye from infection, and disruptions to these mechanisms can lead to epithelial defects and exposure keratopathy, potentially progressing to corneal thinning or perforation if untreated. In our study, 50 patients on ventilator support developed exposure keratitis, primarily due to lagophthalmos, corneal exposure, and dryness, highlighting the link between sedation, neuromuscular blockade, and ocular surface disease. Conclusion: Ocular health in ICU patients is under-researched, despite its significant impact on patient outcomes. Prolonged sedation and lagophthalmos, common in ICU settings, impair eye lubrication and protection, increasing the risk of ocular surface disorders like exposure keratopathy and infections. Additionally, the focus on life-threatening conditions often neglects routine ocular care, exacerbating these issues. Early intervention, including regular eye assessments, lubricants, and proper hygiene, can prevent corneal damage, reduce infection risks, and improve patient comfort.

Keywords: ICU patients; sedation; lagophthalmos; keratopathy; Ocular health.