This document discusses eye care for critically ill patients in the ICU. It notes that the eyes can provide important diagnostic clues for underlying diseases and that ICU patients are at risk for various eye complications due to factors like altered blinking reflexes and eyelid closure. It recommends that ICUs assess patients' ability to close eyelids daily and monitor for eye issues weekly. Eye care including cleaning and lubrication every 2 hours is advised for patients unable to close eyes independently. Maintaining eyelid closure or using mechanical methods if needed is also recommended. The use of polyethylene covers is cited as more effective than ointments at preventing corneal abrasions.

2. University of Alexandria
Faculty of Nursing
Critical Care & Emergency Nursing
Department
Mona Saad
Assistant lecturer of Critical Care & Emergency Nursing

4. Introduction
Critically ill patients may
present with multiple organ
involvement.

5. The eye
Is an important & often under
used diagnostic indicator of
disease.
Ophthalmologic symptoms are
important to make an
appropriate diagnosis.

6. The conjunctiva Tears
Eye protective barriers
Blinking reflex Eyelid closure

7. Altered Muscle Other MV Tight ETT
LOC relaxant medications PEEP securing tape
Altered blinking Altered eyelid
reflex closure
↑ Tear film ↑ Risk of eye
evaporation dryness
Serious eye complications

8. Chemosis “Conjunctival edema”
Conjunctivitis ‘ventilator eye’ Keratitis
The potential eye
problems in ICU patients
Bacterial /
exposure keratitis
Corneal ulcers Corneal abrasion

9. Unfortunately…
Anticipating & preventing eye problems in
patients who may have exposure of the
cornea is not a common practice.

10. Eye problems in ICU patients
The exact magnitude of the problem can not be
exactly estimated
Poor documentation of eye assessment findings.
The eye care is often seen as a minor problem
which represents low priority in comparison to
other intervention specially those directed to the
management of life threatening problems.

11. Eye problems in ICU patients
The reported incidence rates for corneal abrasion
vary widely in the international literature.
3-60% of critically ill patients are affected with
corneal abrasion “peak incidence at 2-7 days of
ICU admission “.

12. A basic nursing procedure essential for all critically
ill patients .
Eye care in the ICU is often applied with
considerable variation from one health care facility to
the other.

13. Evidence based
practice
recommendations
for
Eye care in ICU

14. Evidence based recommendations for
eye care in ICU
Assessment
Eye care
Eyelid closure

15. Assessment
Assessment of patients’ ability to maintain an
eyelid closure should be performed daily in
critically ill patients.
Grade of recommendation D
Observation for iatrogenic ophthalmologic
complications should be performed at least
weekly in critically ill patients using practical
methods.
Grade of recommendation D

16. Assessment
All ICUs should monitor the rate of iatrogenic
ophthalmologic complications.
Grade of recommendation D
Referral must be made in a timely manner for
any suspected iatrogenic ophthalmologic
complications in critically ill patients.
Grade of recommendation D

17. Eye care
Eye care should be part of the care provided to
all people during their admission to the ICU.
Level II.
Ointments & drops are more effective at reducing
the incidence of corneal abrasions than no eye
instillations. Level II.

18. Eye care
All patients who cannot achieve eyelid closure
independently & unconscious or heavily sedated
patients should receive eye care every 2 hrs
(cleaning with saline soaked gauze & the
administration of an eye specific lubricant).
Grade of recommendation C.

19. Eyelid closure
Eyelid closure should be maintained in intensive
care patients who cannot maintain complete
eyelid closure. Grade of recommendation D.
If eyelid closure cannot be maintained passively
then mechanical methods should be used.
Grade of recommendation C.

20. Eyelid closure
Polyethylene covers
are more effective at reducing the incidence of
corneal abrasions than ointments & drops. Level II

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22. References
Andrea P, Elliott R, Rolls K, Schacht S. Eyecare in the critically ill: clinical
practice guideline. Australian College of Critical Care Nurses 2008; 21(2):
97-109.
Mui S. Making a difference in eye care: using gladwrap in eye care of ICU
patients. Hong Kong Association of Critical Care Nurses 2003; 5(1):1-6.
Ramirez F, Ibarra S, Varon J, Tang R. The neglected eye:
ophthalmologic issues in the intensive care unit. Critical Care & shock
2008; 11:72-82.
Desalu I, Akinsola F, Adekola O, Akinbami O, Kushimo O, Adefule A.
Ocular surface disorders in intensive care unit patients in a sub-saharan
teaching hospital. The Internet Journal of Emergency and Intensive Care
Medicine 2008 ; 11 (1):1-8.