title: Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: a cohort study.
abstract: OBJECTIVE
  Recent emphasis on eye care in intensive care unit (ICU) patients has translated to eye assessment being part of routine care. In this setting, we determined the incidence, risk factors, and resolution time of exposure keratopathy.
  
  
  METHODS
  In this prospective cohort study, 301 patients were examined within 24 hours of ICU admission and subsequently daily by an ophthalmologist till death or discharge. Eyelid position, conjunctival and corneal changes, treatment, and outcome data were collected.
  
  
  RESULTS
  Admission diagnoses included febrile illnesses (35.2%) and respiratory failure (32.6%); 84.1% were ventilated. Forty-nine patients had exposure keratopathy (bilateral = 35, unilateral = 14) at admission; 35 patients developed new onset keratopathy (incidence 13.2%) 4.6 ± 2.6 days after ICU admission. In 67 patients, keratopathy was mild (punctate epithelial erosions). Macroepithelial defects (n = 9), stromal whitening with epithelial defect (n = 3), and stromal scar (n = 3) were infrequent. None developed microbial keratitis. On multivariate logistic regression analysis, eyelid position (odds ratio, 2.93; 95% confidence interval, 1.37-6.25), and ventilation duration (odds ratio, 1.11; 95% confidence interval, 1.04-1.19) were strongly associated with the development of keratopathy after ICU admission. Keratopathy resolved in 3.6 ± 4.5 days.
  
  
  CONCLUSIONS
  Severe exposure keratopathy is infrequent in a protocolized ICU setting. Eyelid position and duration of ventilation are associated with exposure keratopathy.
authors.affiliation: Department of Ophthalmology, Schell hospital, Christian Medical College, Vellore, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Kuruvilla
authors.affiliation: Department of Ophthalmology, Schell hospital, Christian Medical College, Vellore, India.
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Peter
authors.affiliation: Department of Ophthalmology, Schell hospital, Christian Medical College, Vellore, India.
authors.forename: Sarada
authors.initials: S
authors.lastname: David
authors.affiliation: Department of Biostatistics, Christian Medical College, Vellore, India.
authors.forename: Prasanna Samuel
authors.initials: PS
authors.lastname: Premkumar
authors.affiliation: Medical Intensive Care Unit, Christian Medical College, Vellore, India.
authors.forename: Kartik
authors.initials: K
authors.lastname: Ramakrishna
authors.affiliation: Medical Intensive Care Unit, Christian Medical College, Vellore, India.
authors.forename: Lovely
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Medical Intensive Care Unit, Christian Medical College, Vellore, India.
authors.forename: Manuel
authors.initials: M
authors.lastname: Vedakumar
authors.affiliation: Medical Intensive Care Unit, Christian Medical College, Vellore, India. Electronic address: peterjohnvictor@yahoo.com.au.
authors.forename: John Victor
authors.initials: JV
authors.lastname: Peter
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003316:Corneal Diseases / Q000453:epidemiology*; D016638:Critical Illness / Q000453:epidemiology*; D054810:Deep Sedation / Q000706:statistics & numerical data*; D005143:Eyelids; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D009466:Neuromuscular Blocking Agents
keywords: Critically ill; Exposure keratopathy; Incidence; Risk factors