Corneal protection in critically ill patients: a randomized controlled trial of three methods

Objective: The aim of this study was to compare the efficacy of three commonly used methods of corneal protection in critically ill patients.Design: Prospective, randomized, observer-blinded trial.Setting: Mixed 10-bed medical/surgical intensive care unit (ICU) and a 10-bed neurosurgical ICU in a university teaching hospital.Subjects: Thirty-one critically ill, ventilated patients with loss of blink reflex for more than 24 hours.Interventions: Patients received standard eye care in one eye and were randomized to receive either taping or application of a gel membrane to the opposite eye.Measurements and main results: Patients' corneas were examined at enrolment and every 24 hours thereafter during the study period. Eyes were stained with fluorescein and examined using a light source with a cobalt-blue filter. Keratopathy was seen in 23% (7/31) of patients at some stage during the study period. Corneal abnormalities were only observed in eyes where lagophthalmos was present. Keratopathy developed in 14% (4/28) of eyes treated with standard care, 7% (1/14) of eyes treated with the gel membrane, and no eyes treated with taping (0/14). These differences did not reach statistical significance.Conclusions: Superficial keratitis is very common in critically ill patients who have lagophthalmos and are treated with ocular lubricants alone. Prophylactic taping of the eyelids appears to be safe even in patients who require frequent pupillary examination.