The Effects of Passive Blinking on Exposure Keratopathy among Patients in Intensive Care Units

Korosh Rezaei, Nazanin Amini, Reza Rezaei, Fatemeh Rafie, Mehdi Harorani

Abstract


Background: Patients in Intensive Care Units (ICUs) are at risk of eye disorders such as Exposure keratopathy (EK) due to impaired blinking and incomplete eye closure. The aim of this study was to assess the effects of passive blinking exercise (PBE) on EK among patients in ICUs.

Materials and Methods: This single‑blind, randomized, clinical trial was conducted in 2017. The study participants included 51 patients purposively recruited from the three ICUs of Valiasr Teaching Hospital, Arak, Iran. Through coin tossing, one eye of each participant was randomly allocated to the intervention group and the other to the control group. The eye in the control group received routine eye care, whereas the eye in the intervention group received routine eye care and PBE for a week. EK prevalence and severity were assessed daily for 7 consecutive days using fluorescein eye staining papers and an ophthalmoscope with a cobalt blue filter.

Results: The study groups did not significantly differ from each other in terms of the baseline prevalence and severity of EK. After the intervention, the prevalence of EK (χ2 = 13.44, df = 1, p < 0.001) and the prevalence of grade II EK (χ2 = 8.33, df = 1, p = 0.003) in the intervention group were significantly lower than the control group.

Conclusions: PBE is effective in significantly reducing EK prevalence and severity among patients in ICUs. Therefore, critical care nurses are recommended to use PBE for EK prevention and management.


Keywords


Blinking, corneal injuries, intensive care units, nurses

Full Text:

PDF

References


Hartford JB, Bian Y, Mathews PM, De Rojas J, Garg A, Rasool N, et al. Prevalence and risk factors of exposure keratopathy across different intensive care units. Cornea 2019;38:1124 30.

Kousha O, Kousha Z, Paddle J. Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults: A two phase prospective cohort study. Critical Care 2018;22:1 8.

Yao L, Luo Y, Wang Y, Zhang Z, Tian J, Yang L, et al. Comparative efficacy of various preventive methods for exposure keratopathy among critically ill patients: A network meta analysis of randomized controlled trials. Int J Nurs Stud 2021;118:103926. doi: 10.1016/j.ijnurstu. 2021.103926.

Azfar MF, Khan MF, Alzeer AH. Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit. Saudi J Anaesth 2013;7:33.

Kuruvilla S, Peter J, David S, Premkumar PS, Ramakrishna K, Thomas L, et al. Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: A cohort study. J Crit Care 2015;30:400 4.

Kam KR, Haldar S, Papamichael E, Pearce KC, Hayes M, Joshi N. Eye care in the critically ill: A national survey and protocol. J Intensive Care Soc 2013;14:150 4.

Oliveira RS, Fernandes APN de L, Botarelli FR, Araújo JN de M, Barreto VP, Vitor AF. Risk factors for injury in the cornea in critical patients in intensive care: An integrative review. Revista de Pesquisa: Cuidado é Fundamental Online 2016;8:4423 34.

McMonnies CW. Incomplete blinking: Exposure keratopathy, lid wiper epitheliopathy, dry eye, refractive surgery, and dry contact lenses. Contact Lens Anterior Eye 2007;30:37 51.

Kocaçal Güler E, Eşer İ, Eğrilmez S. Nurses can play an active role in the early diagnosis of exposure keratopathy in intensive care patients. Jpn J Nurs Sci 2018;15:31 8. 10. Khatiban M, Moradi Amin H, Falahinia G, Moghimbeigi A, Yadollahi M. Polyethylene eye cover versus artificial teardrops in the prevention of ocular surface diseases in comatose patients: A prospective multicenter randomized triple blinded three arm clinical trial. PloS One 2021;16:e0248830.

Nosch DS, Pult H, Albon J, Purslow C, Murphy PJ. Relationship between corneal sensation, blinking, and tear film quality. Optometry Vis Sci 2016;93:471 81.

Hanstock HG, Edwards JP, Walsh NP. Tear lactoferrin and lysozyme as clinically relevant biomarkers of mucosal immune competence. Front Immunol 2019;10:1178.

Rodriguez JD, Lane KJ, Ousler III GW, Angjeli E, Smith LM, Abelson MB. Blink: Characteristics, controls, and relation to dry eyes. Curr Eye Res 2018;43:52 66.

Davoodabady Z, Rezaei K, Rezaei R. The impact of normal saline on the incidence of exposure keratopathy in patients hospitalized in intensive care units. Iran J Nurs Midwifery Res 2018;23:57.

Sivasankar S, Jasper S, Simon S, Jacob P, John G, Raju R. Eye care in ICU.Indian J Crit Care Med 2006;10:11 4.

So HM, Lee CC, Leung AK, Lim JM, Chan CS, Yan WW. Comparing the effectiveness of polyethylene covers (GladwrapTM) with lanolin (Duratears®) eye ointment to prevent corneal abrasions in critically ill patients: A randomized controlled study. Int J Nurs Stud 2008;45:1565 71.

Sharjeel M, Malik IQ. Prevention of exposure keratopathy with sahaf wet chamber. Pak J Ophthalmol 2015;31:131 6.

Saritas TB, Bozkurt B, Simsek B, Cakmak Z, Ozdemir M, Yosunkaya A. Ocular surface disorders in intensive care unit patients. ScientificWorldJournal 2013;2013. doi: 10.1155/2013/182038.

Jammal H, Khader Y, Shihadeh W, Ababneh L, AlJizawi G, AlQasem A. Exposure keratopathy in sedated and ventilated patients. J Crit Care 2012;27:537 41.

Shan H, Min D. Prevention of exposure keratopathy in intensive care unit. Int J Ophthalmol 2010;3:346.

McHugh J, Alexander P, Kalhoro A, Ionides A. Screening for ocular surface disease in the intensive care unit. Eye 2008;22:1465 8.

Motarjemizadeh G, Hasanloei MA, Pakzad S, Asghari M. Frequency and outcome of exposure keratitis in mechanical ventilated patients admitted to intensive care unit. J Urmia Univ Med Sci 2018;29. Available from: http://umj.umsu.ac.ir/browse. php?a_id=4423&sid=1&slc_lang=fa&ftxt=1.

Bird B, Dingley S, Stawicki SP, Wojda TR. Exposure keratopathy in the intensive care unit: Do not neglect the unseen. Vignettes Patient Saf 2017;2:131 49.

Ezra DG, Chan MP, Solebo L, Malik AP, Crane E, Coombes A, et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med 2009;35:455 61.


Refbacks

  • There are currently no refbacks.