Prevention of Corneal Injury in Critically Ill Sedated and Mechanically Ventilated Patients: Theoretical and Evidence-based Practice

Abstract

Any prolonged loss of consciousness due to sedation in critically ill patients may result in eye injuries which may go unnoticed as the patient cannot express his/her reduced vision or pain. Loss of blinking movement and eyelid malocclusion can cause some eye injuries as keratopathies and ulcers, which are the most common eye injuries in these patients. In at-risk patients (intubated and ventilated), screening for corneal injuries should be carried out using a fluorescein test. Protection of the cornea depends on its moisturization, which itself depends on eyelid closure, blinking, and the quality of the aqueous film present on the cornea. These protective components are regularly reduced in critically ill patients. Some cohort studies indicate that the peak incidence of corneal injuries occurs after first-week admission in critically ill patients. In intubated and ventilated patients, an eye gel and polyethylene chamber are the most effective interventions to prevent corneal injuries.