Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown.
BACKGROUND
Patients who are comatose or semicomatose are at risk of corneal dryness and ulceration.


OBJECTIVE
To compare and evaluate the effectiveness of two treatments used for the prevention of corneal epithelial breakdown in critically ill patients.


METHODS
A randomized clinical trial was used. The sample consisted of critically ill patients (age, 15-84 years) with a limited or absent blink reflex in a 14-bed general intensive care unit in a large metropolitan teaching hospital. Ninety-six eligible patients were studied; of these, 36 were excluded and data from the remaining 60 patients were analyzed. Patients were randomized to receive methylcellulose lubricating drops every 2 hours (n = 30) or to have their eyes covered with a polyethylene film to create a moisture chamber (n = 30). The patients' corneas were tested daily for epithelial breakdown using fluorescein drops. Patients were studied for a minimum of 48 hours and a maximum of 1 week.


RESULTS
Eight of the 30 patients in the lubricating drop group had positive fluorescein staining, compared with one in the moisture chamber group.


CONCLUSIONS
Our results suggest that a moisture chamber is more effective than lubricating drops in preventing corneal epithelial breakdown in critically ill patients with limited or absent blink reflex.
Cortese
D
D
Royal Melbourne Hospital, Victoria, Australia.
Capp
L
L
McKinley
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001767:Blinking; D016009:Chi-Square Distribution; D003128:Coma / Q000150:complications*; D003315:Cornea / Q000503:physiopathology / Q000648:ultrastructure; D003422:Critical Care / Q000191:economics / Q000379:methods; D006801:Humans; D006813:Humidity; D007634:Keratitis / Q000209:etiology / Q000517:prevention & control*; D008153:Lubrication; D008747:Methylcellulose / Q000627:therapeutic use; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010592:Pharmaceutic Aids / Q000627:therapeutic use; D011095:Polyethylenes
D009883:Ophthalmic Solutions; D010592:Pharmaceutic Aids; D011095:Polyethylenes; D008747:Methylcellulose