Skip to main content

Advertisement

Log in

Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 12 November 2008

Abstract

Purpose

To compare the cost and effectiveness of the two most popular forms of eye care in intensive care, ocular lubricant (Lacrilube) and polyacrylamide hydrogel dressings (Geliperm); for the prevention of exposure keratopathy in the critically ill.

Methods

A prospective randomised contralateral eye study was conducted at the Intensive Care Unit (ICU), Royal London Hospital, London, UK. Eighty eyes of 40 patients were recruited. Each patient received both Lacrilube and Geliperm allocated at random to different sides. A daily ophthalmology ward round was conducted. The outcome measures included the greatest palpebral aperture length, conjunctival oedema, and any exposure keratopathy.

Results

There was no statistically significant difference in the maximum corneal exposure score between the eyes treated with Lacrilube and Geliperm (P = 0.38). No significant difference in degree of chemosis or palpebral aperture was identified.

Conclusions

Our data suggest that Geliperm is as effective as Lacrilube in the prevention of exposure keratopathy in the critically ill. We also note that nursing staff must be fully trained in its application for eye care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wilson L (1982) Bacterial corneal ulcers. In: Duane T (ed) Clinical ophthalmology. Harper & Row, Hagerstown, pp 5–9

    Google Scholar 

  2. Hutton WL, Sexton RR (1972) Atypical Pseudomonas corneal ulcers in semicomatose patients. Am J Ophthalmol 73:37–39

    PubMed  CAS  Google Scholar 

  3. Laight SE (1996) The efficacy of eye care for ventilated patients: outline of an experimental comparative research pilot study. Intensive Crit Care Nurs 12:16–26

    Article  PubMed  CAS  Google Scholar 

  4. Marshall AP, Elliott R, Rolls K, Schacht S, Boyle M (2008) Eyecare in the critically ill: clinical practice guideline. Aust Crit Care 21:97–109

    Article  PubMed  Google Scholar 

  5. King D, Healy M (2003) Prevention of eye disease in intensive care—a telephone survey. Int Care Med 29:15(suppl)

    Google Scholar 

  6. Ezra DG, Lewis G, Healy M, Coombes A (2005) Preventing exposure keratopathy in the critically ill: a prospective study comparing eye care regimes. Br J Ophthalmol 89:1068–1069

    Article  PubMed  CAS  Google Scholar 

  7. Lenart SB, Garrity JA (2000) Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. Am J Crit Care 9:188–191

    PubMed  CAS  Google Scholar 

  8. Ezra D, Chan MPY, Solebo LA, Malik ANJ, Ahmadi-Lari S, Hersch D, Hanouka A, Al-Hakim H, Crane B, Coombes AC, Healy M (2006) Randomised controlled trial comparing Geliperm and Lacrilube Eye care in the Critically ill. Intensive care medicine Int Care Med 32:227(suppl)

    Google Scholar 

  9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  10. McClellan KA (1997) Mucosal defense of the outer eye. Surv Ophthalmol 42:233–246

    Article  PubMed  CAS  Google Scholar 

  11. Kirwan JF, Potamitis T, el-Kasaby H, Hope-Ross MW, Sutton GA (1997) Microbial keratitis in intensive care. BMJ 314:433–434

    PubMed  CAS  Google Scholar 

  12. Mercieca F, Suresh P, Morton A, Tullo A (1999) Ocular surface disease in intensive care unit patients. Eye 13(Pt 2):231–236

    PubMed  Google Scholar 

  13. Ommeslag D, Colardyn F, De Laey JJ (1987) Eye infections caused by respiratory pathogens in mechanically ventilated patients. Crit Care Med 15:80–81

    Article  PubMed  CAS  Google Scholar 

  14. Dua HS (1998) Bacterial keratitis in the critically ill and comatose patient. Lancet 351:387–388

    Article  PubMed  CAS  Google Scholar 

  15. Johnson KL, Kearney PA, Johnson SB, Niblett JB, MacMillan NL, McClain RE (1994) Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 22:658–666

    Article  PubMed  CAS  Google Scholar 

  16. Parkin B, Turner A, Moore E, Cook S (1997) Bacterial keratitis in the critically ill. Br J Ophthalmol 81:1060–1063

    Article  PubMed  CAS  Google Scholar 

  17. Cunningham C, Gould D (1998) Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care. Int J Nurs Stud 35:32–40

    Article  PubMed  CAS  Google Scholar 

  18. Koroloff N, Boots R, Lipman J, Thomas P, Rickard C, Coyer F (2004) A randomised controlled study of the efficacy of hypromellose and Lacri–Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med 30:1122–1126

    Article  PubMed  Google Scholar 

  19. So HM, Lee CC, Leung AK, Lim JM, Chan CS, Yan WW (2008) Comparing the effectiveness of polyethylene covers (Gladwraptrade mark) with lanolin (Duratears((R))) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study. Int J Nurs Stud

  20. Cortese D, Capp L, McKinley S (1995) Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care 4:425–428

    PubMed  CAS  Google Scholar 

  21. Ezra DG, Healy M, Coombes A (2005) Assessment of corneal epitheliopathy in the critically ill. Intensive Care Med 31:313

    Article  PubMed  Google Scholar 

  22. Landsberger HA (1958) Hawthorne revisited: management and the worker: its critics, and developments in human relations in industry. New York State School of Industrial and Labor Relations, Cornell University, Ithaca

  23. Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Thanks to Andrew Ely and Gail Marshall (Audit department) for their help with data collection.

Conflict of interests statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel G. Ezra.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-008-1349-4

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ezra, D.G., Chan, M.P.Y., Solebo, L. et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med 35, 455–461 (2009). https://doi.org/10.1007/s00134-008-1284-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-008-1284-4

Keywords

Navigation