Bacterial keratitis in the critically ill

Parkin, Ben; Turner, Andrew; Moore, Elizabeth; Cook, Stuart D.

doi:10.1136/bjo.81.12.1060

Cited by 51 publications

(33 citation statements)

References 15 publications

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“…3,7,[12][13][14][15] In the largest series, the mean visual acuity of six surviving patients at discharge was 6/60. 12 Although there is likely to be a significant reporting bias in favour of more severe cases among published case reports, it remains striking that so many of these cases were bilateral, with substantially worse outcomes than would be expected in an outpatient setting. A disproportionately large number were due to Pseudomonas, which is responsible for 24.8% of cases of bacterial keratitis in the general population.…”

Section: Introductionmentioning

confidence: 99%

Screening for ocular surface disease in the intensive care unit

McHugh

Alexander

Kalhoro

et al. 2007

Eye

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Purpose Ventilated patients in the intensive care unit (ICU) often develop exposure keratopathy. This predisposes to the development of bacterial keratitis, which in ICU is often bilateral, with a high risk of perforation. As regular examinations of all ventilated patients by ophthalmologists would be impractical, the purpose of this study was to assess whether ICU staff can screen reliably for keratopathy. Methods A prospective study was performed in a general adult ICU. Twice each week, two junior ICU doctors examined the lid position and ocular surface of all patients who had been continuously sedated for more than 24 h, using fluorescein and a pen torch with a blue filter. An ophthalmologist performed similar examinations using a portable slit lamp. Results A total of 48 ocular examinations were performed in 18 patients. Exposure keratopathy was found by the ophthalmologist in 37.5% of examinations and by ICU doctors in 31.3% of examinations. ICU doctors had a sensitivity of 77.8% and a specificity of 96.7% in detecting keratopathy, when compared with the findings of the ophthalmologist. All cases missed by ICU doctors had punctate erosions of less than 5% of the corneal surface. Keratopathy was significantly commoner in patients with incomplete lid closure than in patients with closed lids (70.0 vs 28.9%; two-tailed Fisher's exact test P ¼ 0.027). Conclusions ICU staff can perform screening examinations for exposure keratopathy with reasonable sensitivity and specificity. Regular screening by ICU staff would facilitate appropriate treatment of exposure keratopathy and promote earlier identification of cases of keratitis.

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Section: Introductionmentioning

confidence: 99%

Screening for ocular surface disease in the intensive care unit

McHugh

Alexander

Kalhoro

et al. 2007

Eye

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“…Tear evaporation modifies the conjunctival sac milieu, making bacterial growth difficult [28]. Orbicularis oculi contraction and levator palpebrae superioris inhibition protects the cornea from dryness by shutting the eyelid [29][30][31]. When any of the above components of this highly intricate and interconnected innate eye protection mechanism are interrupted, alone or in combination, whether by disease processes or natural aging mechanisms, the risk of EK increases significantly.…”

Section: Exposure Keratopathy: Pathophysiology Diagnosis Symptoms mentioning

confidence: 99%

“…In another study, authors concentrated on reducing the risk of ocular Pseudomonas aeruginosa infection [29]. Their clinical guideline stipulated that unconscious patients should receive eye care every 2 h. Any swelling, conjunctival hyperemia, corneal clouding, and epithelial loss were noted and recorded.…”

Section: Exposure Keratopathy: Preventive Strategies and Patient Safementioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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“…5 The most common pathogen in the hospital setting is Pseudomonas aeruginosa. 3,4 In this case, however, both ocular and pharyngeal cultures revealed an identical pathogenic strain of S. pyogenes.…”

Section: Discussionmentioning

confidence: 99%

“…An association between the development of keratitis and mechanical ventilation in the intensive care setting has been established. 3,4 Colonization of the respiratory tract with a pathogenic organism often precedes the development of keratitis, a complication that is preventable by use of lubrication, closed moisture chambers, and other means. 5 The most common pathogen in the hospital setting is Pseudomonas aeruginosa.…”

Section: Discussionmentioning

confidence: 99%