OCULAR SURFACE DISORDERS IN THE CRITICALLY ILL

Abnormalities of the cornea and conjunctiva occur in association with neurological diseases, nocturnal lagophthalmos, coma, infection, and m echanical ventilation. We investigated the incidence and causes of ocu lar surface disorders in critically ill patients. In a retrospective s tudy, the presence of conjunctivitis and corneal erosion was determine d by reviewing the medical charts of 143 mechanically ventilated patie nts (intensive care unit [ICU] stay greater than or equal to 7 days). In the subsequent prospective study, 15 patients who had sedatives or muscle relaxants administered continuously for more than 48 h in the I CU were investigated. Corneal erosion was examined using a slit lamp o nce a day. Ocular surface disorder was found in 28 of the 143 patients (20%) whose ICU stay exceeded 7 days. The incidence increased with co ntinuous sedation (35% vs 15%). The incidence also increased with cont inuous neuromuscular blockade (39% vs 11%). In the prospective study, nine patients (60%) developed conceal erosion. A patient's inability t o fully close his or her eyes increased the incidence (P < 0.01) of co nceal erosion. Protective eyelid taping was effective in preventing an d treating the corneal erosion. In conclusion, the critically ill ofte n develop ocular surface disorders, especially when sedated and immobi lized. A close relationship was observed between these conditions and the inability to close one's eyes.