Efficacy of Simple Eye Ointment, Polyethylene Cover, and Eyelid Taping in Prevention of Ocular Surface Disorders in Critically Ill Patients: A Randomized Clinical Trial.

Mehdi Ahmadinejad,Zahra Karzari,Maryam Soltaninejad,Maryam Ahmadipour,Esmat Karbasi,Yunes Jahani

doi:10.1155/2020/6267432

Abstract

Background Under normal conditions, the cornea of the eye is protected from bacterial invasion, physical injury, and drying by the presence of tears, eyelids, and blinking reflex. However, patients admitted to the intensive care unit (ICU) for several reasons including loss of consciousness, receiving sedative and neuromuscular blocking agents, and mechanical ventilation may lose eye-protective mechanisms causing exposure keratopathy. Therefore, this study intended to compare three eye care methods to prevent ocular surface disorders (OSDs) in ICU patients. Methods This study was a double-blind clinical trial (IRCT: 201109225426N3, https://www.irct.ir/trial/5825), in which 152 patients were randomized into three groups and each group underwent a different eye care procedure. The eye care methods included simple eye ointment, polyethylene cover, and eyelid taping. The eligible patients received the care procedure for seven days, and their corneas were examined daily for OSD by a portable slit lamp with fluorescein staining. Descriptive and analytical tests (ANOVA, chi-square, logistic regression, and zero-inflated Poisson regression) were used for statistical analysis by STATA14. Results The odds of OSD (chances of getting an OSD grade between I and VI) in the ointment group were 0.19 (95% CI: 0.09, 0.41), and the odds of OSD in the polyethylene cover group were 0.06 (95% CI: 0.01, 0.20), showing a significant difference with the tape group (p=0.0001). Despite the lower odds of OSD in the cover group than in the ointment group, there was no significant between-group difference (p=0.08). However, the mean OSD scores in both the ointment and polyethylene cover groups were significantly lower than that in the tape group. Conclusion The results of this study showed that polyethylene cover followed by simple eye ointment and eyelid taping were the most effective methods in preventing OSD. Therefore, polyethylene cover and simple eye ointment are recommended as effective eye care methods in ICU.

Highlights

Given the importance of visual perception, strategies have been proposed to maintain the proper function of anatomical and physiological structures of the eyes [1]. e presence of tears and blinking reflex are two factors that protect corneal epithelium against infection and dryness [2, 3]. e tear film consists of three layers and performs important functions, including feeding the corneal epithelium, sliding the corneal surface, and counteractingCritical Care Research and Practice infections
According to Ezra et al, different eye care methods are used in intensive care unit (ICU) patients, but they are not evidence-based and cannot determine the best care method. ey evaluated the effects of three eye protection methods including Lacri-Lube ointment, Geliperm dressing, and simple eye care with sterile water on prevention of exposure keratopathy in ICU patients and reported the superiority of the ophthalmic lubricant over the others [13]
Shan and Min (2010) compared the effectiveness of three methods, namely, eye drops, moist chamber, and polyethylene cover, in preventing exposure keratopathy in ICU patients. e results indicated that moist chamber and polyethylene cover were more effective than artificial tears

Summary

Introduction

Given the importance of visual perception, strategies have been proposed to maintain the proper function of anatomical and physiological structures of the eyes [1]. e presence of tears and blinking reflex are two factors that protect corneal epithelium against infection and dryness [2, 3]. e tear film consists of three layers and performs important functions, including feeding the corneal epithelium, sliding the corneal surface, and counteractingCritical Care Research and Practice infections. The effectiveness of three eye care methods including simple eye ointment, polyethylene cover, and eyelid taping in patients with impaired blinking reflex in ICU was assessed. Is study tended to investigate the efficacy of three eye care methods in the prevention of ocular surface disorders in ICU patients.

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