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Warad C, Mohapatra S, Mehta A. Bedside assessment of ophthalmic manifestations in neurocritical care: A study in Southern India. Indian J Ophthalmol 2024; 72:201-205. [PMID: 38099377 PMCID: PMC10941915 DOI: 10.4103/ijo.ijo_2878_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE This study aimed to investigate the incidence of Ocular Surface Disorders (OSDs), including Dry Eye Disease, Chemosis, and Exposure Keratitis, among patients admitted to the Neurocritical Care Unit (NCC). Additionally, we sought to assess the correlation between these OSDs, the length of hospitalization at NCC, and the Glasgow Coma Score (GCS). The heightened risk of OSD development in the NCC environment, coupled with pre-existing neurological impairments, can lead to conditions like dry eye disease, chemosis, corneal abrasions, and infectious keratitis, ultimately resulting in corneal opacities and perforations that significantly impact visual acuity and overall quality of life. METHODS In this observational cross-sectional study, we examined the ocular health of all patients admitted to an NCC unit from February to May 2022. We assessed the presence of Conjunctivitis, chemosis, Keratitis, and Dry Eyes in relation to the duration of stay at NCC, GCS, lagophthalmos, adherence to the prescribed eye care protocol in NCC, and the use of mechanical ventilation. Our study comprised one hundred subjects over a four-month period, with a mean age of 51.92 ± 18.73 years (ranging from 17 to 89), including 70% males and 30% females (gender ratio of 2.33). RESULTS Our findings revealed that 26 eyes (13%) exhibited Conjunctival Hyperemia, 23 eyes (11.5%) displayed Chemosis, and severe dry eye was prevalent in 41 (20.5%) eyes. A statistically significant association was observed between GCS (p-value <0.001) and Keratitis (p-value 0.0035) with dry eyes (Chi-Square Test). Notably, the incidence of dry eyes was significantly higher among patients with a prolonged stay of ≥10 days (p-value 0.003). CONCLUSIONS Patients admitted to Neurocritical Care Units necessitate meticulous eye care and structured protocols to mitigate the risk of long-term ocular complications such as exposure keratitis. Given their heightened susceptibility to these conditions, proactive measures are imperative to ensure optimal ocular health among NCC patients.
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Affiliation(s)
- Chethana Warad
- Department of Ophthalmology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (KAHER), Belagavi, Karnataka, India
| | - Shrusty Mohapatra
- Department of Neurosurgery and Neurology, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Abhyudaya Mehta
- Department of Neurosurgery and Neurology, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
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Chen Y, He J, Wu Q, Pu S, Song C. Prevalence and risk factors of exposure keratopathy among critically ill patients: A systematic review and meta-analysis. Nurs Open 2024; 11:e2061. [PMID: 38268267 PMCID: PMC10721942 DOI: 10.1002/nop2.2061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS To identify the incidence, prevalence and risk factors of exposure keratopathy (EK) among critically ill patients. DESIGN Systematic review and meta-analysis, in accordance with the PRISMA 2020 Statement. METHODS The Cochrane Library, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), Weipu Database (VIP) and WanFang Database were systematically searched from inception to June 2022. Observational studies that reported EK among paediatric and adult critically ill patients were screened and included original articles based on the inclusion criteria. Two reviewers independently completed data extraction and quality assessments. Subgroup analysis investigated potential causes of heterogeneity. RESULTS Of the 4508 studies identified, 23 studies involving 3519 subjects were included. The pooled prevalence of EK was 34.0%, and the pooled incidence rate of EK was 23.0%. Risk factors associated with EK in critically ill patients included lagophthalmos, chemosis, eye blinks <5 times per minute, mechanical ventilation, sedation, lower Glasgow Coma Scale (GCS) score and higher Acute Physiology and Chronic Health Evaluation (APACHE) II score. CONCLUSION This review shows that EK rates are high in critically ill patients and are influenced by multiple factors. Medical staff should pay more attention to EK in critically ill patients, conduct professional evaluations and implement targeted eye care protocols to reduce its occurrence. IMPLICATIONS FOR PRACTICE This study shows the frequency of and multiple risk factors for EK in critically ill patients, which provides evidence-based guidance for nurses to evaluate the risk of EK in critically ill patients and take appropriate precautions to reduce the risk. PROTOCOL REGISTRATION The protocol was registered in PROSPERO (https://www.crd.york.ac.uk/prospero/) (CRD42022346964). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yulu Chen
- Department of OtolaryngologyThe Second Affiliated Hospital of Army Medical UniversityChongqingChina
| | - Jing He
- Department of NursingThe Second Affiliated Hospital of Army Medical UniversityChongqingChina
| | - Qiuping Wu
- Department of CardiologyThe Second Affiliated Hospital of Army Medical UniversityChongqingChina
| | - Shi Pu
- Department of NephrologyThe Second Affiliated Hospital of Army Medical UniversityChongqingChina
| | - Caiping Song
- President OfficeThe Second Affiliated Hospital of Army Medical UniversityChongqingChina
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Tran E, Phu V, Xu R, Teoderascu A, Aly M, Shah N, Malvankar-Mehta MS. Ocular manifestations of COVID-19: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00248-X. [PMID: 37683691 DOI: 10.1016/j.jcjo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/30/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Our study aims to build on our understanding of COVID-19 by detailing a comprehensive look at the prevalence of different ocular manifestations related to COVID-19 infection. DESIGN Systematic review and meta-analysis. METHODS Eligible studies published between June 20, 2021, and May 11, 2023, were retrieved from the MEDLINE, EMBASE, and CINAHL databases as well as grey literature. Covidence was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, a risk-of-bias assessment was carried out. Data were extracted, and a meta-analysis was performed using STATA 14.0. Fixed-effects and random-effects models were computed based on heterogeneity. RESULTS Our meta-analysis included 43 articles with a total of 10,572 subjects. The results showed that COVID-19 patients had a significantly higher prevalence of conjunctivitis (effect size [ES] = 0.11; 95% CI, 0.07-0.15), ptosis (ES = 0.22; 95% CI, 0.15-0.30), and ophthalmoplegia (ES = 0.40; 95% CI, 0.06-0.74). Our results also indicate that COVID-19 patients have higher prevalence of cotton wool spots (ES = 0.06; 95% CI, 0.03-0.09), retinal hemorrhages (ES = 0.12; 95% CI, 0.06-0.18), and retinal vein tortuosity (ES = 0.19; 95% CI, 0.09-0.35). CONCLUSION COVID-19 can exhibit extrapulmonary manifestations, affecting both the anterior and posterior segments of the eye. Common anterior-segment findings include conjunctivitis, whereas posterior-segment findings may include cotton wool spots, retinal hemorrhages, and retinal vein tortuosity. Improving our understanding of the ocular manifestations of COVID-19 has the potential to facilitate quicker diagnosis and subsequent treatment.
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Affiliation(s)
- Edward Tran
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Vivian Phu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Riley Xu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Angela Teoderascu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Mohamed Aly
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Nirmit Shah
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
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Susiyanti M, Daniel H, Faridah D, Devona DA, Pramitha P, Bela B, Haryanto B, Barliana JD, Estu D, Victor AA, Putri ND, Candra J, Sutandi N, Sitorus RS. Incidence and clinical characteristic of ocular surface manifestation: an evaluation of conjunctival swab results in Corona Virus 2019 (COVID-19) patients in Jakarta, Indonesia. J Ophthalmic Inflamm Infect 2023; 13:20. [PMID: 37097586 PMCID: PMC10127182 DOI: 10.1186/s12348-023-00343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the spectrum of ocular characteristics and viral presence in the conjunctival swab of patients with COVID-19. METHODS In this cross-sectional study, fifty-three patients were recruited from two COVID-19 referral hospitals in Jakarta (Cipto Mangunkusumo Hospital and Persahabatan Hospital) from July 2020 to March 2021. The inclusion criteria were patients who were suspected of or confirmed cases of COVID-19 with or without ocular symptoms. Demographic data, history of COVID-19 exposure, underlying medical condition, systemic symptoms, ocular symptoms, supporting laboratory results, reverse-transcriptase polymerase chain reaction (RT-PCR) of naso-oropharyngeal (NOP) swab and conjunctival swab were collected. RESULTS Fifty-three patients who were suspected, probable or confirmed cases of Covid-19 were included. Forty-six out of 53 patients (86.79%) tested positive for either Covid-19 antibody rapid test or naso-oropharyngeal (NOP) swab. Forty-two patients tested positive for NOP swab. Fourteen out of 42 patients (33.33%) experienced symptoms of ocular infection including red eye, epiphora, itchy eyes, and eye discharge. None of these patients were tested positive for conjunctival swab. Two out of 42 patients (4.76%), who were tested positive for conjunctival swab, did not experience any ocular symptoms. CONCLUSIONS Establishing the relationship between Covid-19 infection, ocular symptoms, and presence of SARS-CoV-2 virus on the ocular surface proves to be challenging. In Covid-19 patients, ocular symptoms did not warrant a positive conjunctival swab result. On the contrary, a patient without ocular symptoms can also have detectable presence of SARS-CoV-2 virus on the ocular surface.
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Affiliation(s)
- Made Susiyanti
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia
| | - Hisar Daniel
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia
| | - Diah Faridah
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
| | - Dinda Arken Devona
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
| | - Pradnya Pramitha
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
| | - Budiman Bela
- Department of Clinical Microbiology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Budi Haryanto
- Department of Clinical Microbiology, Faculty of Medicine Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
| | - Julie Dewi Barliana
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia
| | - Dian Estu
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia
| | - Andi Arus Victor
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia
| | - Nina Dwi Putri
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Julius Candra
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia
| | - Nathania Sutandi
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia
| | - Rita S Sitorus
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jalan Kimia No. 8-10, Jakarta, 10320, Indonesia.
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Dantas AC, Costa ML, Silva ABD, Borges BEC, Araújo JNDM, Vitor AF. Eye Care Interventions in Critical/Surgical Patients in the Prone Position: Scoping Review. AQUICHAN 2022. [DOI: 10.5294/aqui.2022.22.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: This study aimed to map evidence of eye care interventions in managing critical or surgical patients submitted to prone positions. Materials and method: This scoping review was prepared according to the Joanna Briggs Institute’s methodology, following the PRISMA-ScR criteria. A search was conducted from July to August 2020 in the SCOPUS, Web of Science, Science Direct, PubMed Central, CINAHL, and COCHRANE databases. The following research question was delimited: “What are the strategies and interventions used for eye care in the management of critical patients or surgical patients submitted to the prone position?” The sample consisted of 24 studies after applying the inclusion and exclusion criteria. Results: Eye care interventions in managing critical/surgical patients submitted to the prone position were eye examination, use of lubricants/specific ophthalmic solution, reverse Trendelenburg positioning, and protection with adhesive tape. Conclusions: This review allowed the understanding of eye care for critical/surgical patients in a prone position. Among the care presented, a large part is related to nursing since it is closer to patient care. The findings emphasize the need to implement patient safety policies with eye care as a priority.
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