title: Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study.
abstract: BACKGROUND
  In unconscious ventilated patients, various eye protective measures have been used to prevent corneal abrasions. Two randomized controlled studies in Australia had compared the effectiveness of polyethylene films and eye instillations to prevent corneal abrasions but results were inconsistent. The local acceptance of polyethylene films as a standard eye protective measure is still limited.
  
  
  OBJECTIVE
  Our study aims to compare the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment in the prevention of corneal abrasions in critically ill patients.
  
  
  METHODS
  A prospective randomized controlled study was conducted between April 2004 and December 2005.
  
  
  METHODS
  One hundred and twenty ventilated patients admitted to the intensive care unit (ICU) were randomly assigned to receive either polyethylene covers or lanolin eye ointment to prevent corneal abrasions.
  
  
  METHODS
  All participants received a standard eye care regime together with the eye protective interventions. A fluorescein stain test was performed by the eye care team daily and then weekly to detect any corneal abrasions.
  
  
  RESULTS
  Four participants were not included in the data analysis as they died soon after commencement of the study. A total of 116 patients were included in the final analysis. Of the seven patients (6.0%) that had a positive fluorescein test, four (6.8%) were in the polyethylene covers group (n=59) and three (5.3%) were in the lanolin eye ointment group (n=57). This was not statistically significant (p=0.519). One patient in the lanolin eye ointment group had an eye infection. Upon follow-up of those patients with positive fluorescein test results, two patients spontaneously converted to stain negative within 24h and two patients died before the ophthalmologist's assessment. The remaining three patients were diagnosed to have epithelial cell loss without corneal abrasions.
  
  
  CONCLUSIONS
  With the implementation of a standardized eye care protocol, polyethylene cover is found to be equally effective in preventing corneal abrasions when compared with lanolin eye ointment. The additional benefit of polyethylene cover as a physical barrier to protect patients' eyes needed further evaluation.
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, China. sohm@ha.org.hk
authors.forename: Hang Mui
authors.initials: HM
authors.lastname: So
authors.forename: Carmen Chun Heung
authors.initials: CC
authors.lastname: Lee
authors.forename: Anne Kit Hung
authors.initials: AK
authors.lastname: Leung
authors.forename: Jean Marie Jin Ai
authors.initials: JM
authors.lastname: Lim
authors.forename: Christine Suk Ching
authors.initials: CS
authors.lastname: Chan
authors.forename: Wing Wa
authors.initials: WW
authors.lastname: Yan
mesh_terms: D016009:Chi-Square Distribution; D015400:Clinical Nursing Research; D003128:Coma / Q000150:complications / Q000451:nursing; D065306:Corneal Injuries; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000451:nursing*; D005131:Eye Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005135:Eye Protective Devices / Q000592:standards*; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007809:Lanolin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D020959:Polyethylene / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D005456:Fluorescent Dyes; D009824:Ointments; D007809:Lanolin; D020959:Polyethylene; D019793:Fluorescein