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

Abstract

Objective

To compare the efficacy of two forms of eye care (hypromellose and Lacri-Lube combination vs polyethylene/Cling wrap covers) for intensive care patients.

Design

Randomised-controlled trial.

Setting

University affiliated, tertiary referral hospital.

Patients and participants

One hundred ten patients with a reduced or absent blink reflex were followed through until they regained consciousness, were discharged from the facility during study enrolment, died or developed a positive corneal ulcer or eye infection.

Interventions

All patients received standard eye cleansing every 2 h. In addition to this, group one (n=60) received a treatment combining hypromellose drops and Lacri-Lube (HL) to each eye every 2 h. Group two (n=50) had polyethylene covers only placed over the eye to create a moisture chamber.

Measurements and results

Corneal ulceration was determined using corneal fluorescein stains and mobile slit lamp evaluation, performed daily. No patients had corneal ulceration in the polyethylene cover group, but 4 patients had corneal ulceration in the HL group.

Conclusions

Polyethylene covers are as effective as HL in reducing the incidence of corneal damage in intensive care patients.

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

References

  1. 1.

    Hernandez EV, Mannis MJ (1997) Superficial keratopathy in intensive care unit patients. Am J Ophthalmol 124:212–216

    CAS  PubMed  Google Scholar 

  2. 2.

    Imanaka H, Taenaka N, Nakamura J, Aoyama K, Hosotani H (1997) Ocular surface disorders in the critically ill. Anesth Analg 85:343–346

    CAS  PubMed  Google Scholar 

  3. 3.

    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

    CAS  PubMed  Google Scholar 

  4. 4.

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

    PubMed  Google Scholar 

  5. 5.

    Farrell M, Wray F (1993) Eye care for ventilated patients. Intensive Crit Care Nurs 9:137–141

    CAS  PubMed  Google Scholar 

  6. 6.

    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

    CAS  PubMed  Google Scholar 

  7. 7.

    Fleiss J (1981) Statistical methods for rates and proportions. John Wiley, New York

  8. 8.

    Astori IP, Muller MJ, Pegg SP (1998) Cicatricial, postburn ectropion and exposure keratitis. Burns 24:64–67

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Spencer T, Hall AH, Stawell R (2002) Ophthalmologic sequelae of thermal burns over ten years at the Alfred Hospital. Ophthal Plast Reconstr Surg 18:196–201

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Boyd-Monk H, Steinmetz III C (1987) Nursing care of the eye. Appleton and Lange, Norwalk, Connecticut

  11. 11.

    Sullivan J, Brooks-Crawford J, Whitcher J (1999) Lids, lacrimal apparatus and tears. In: Vaughan D, Asbury T, Riordan-Eva P (ed) General ophthalmology. Appleton and Lange, Stamford, Connecticut, pp 74–91

  12. 12.

    Gilbard J (2000) Dry-eye disorders. In: Albert D, Jakobiec F (ed) Principles and practice of ophthalmology. WB Saunders, Philadelphia, pp 982–1001

  13. 13.

    Newell F (1996) Ophthalmology: principles and concepts. Mosby, St. Louis

  14. 14.

    Parkin B, Cook S (2000) A clear view: the way forward for eye care on ICU. Intensive Care Med 26:155–156

    CAS  PubMed  Google Scholar 

  15. 15.

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

    CAS  Google Scholar 

  16. 16.

    Wincek J, Ruttum MS (1989) Exposure keratitis in comatose children. J Neurosci Nurs 21:241–244

    CAS  PubMed  Google Scholar 

  17. 17.

    Lloyd F (1990) Making sense of eye care for ventilated or unconscious patients. Nurs Times 86:36–37

    Google Scholar 

  18. 18.

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

    CAS  PubMed  Google Scholar 

  19. 19.

    Batra YK, Bali IM (1977) Corneal abrasions during general anesthesia. Anesth Analg 56:363–365

    CAS  PubMed  Google Scholar 

  20. 20.

    Siffring PA, Poulton TJ (1987) Prevention of ophthalmic complications during general anesthesia. Anesthesiology 66:569–570

    CAS  PubMed  Google Scholar 

  21. 21.

    Grover VK, Kumar KV, Sharma S, Sethi N, Grewal SP (1998) Comparison of methods of eye protection under general anaesthesia. Can J Anaesth 45:575–577

    CAS  PubMed  Google Scholar 

  22. 22.

    Orlin SE, Kurata FK, Krupin T, Schneider M, Glendrange RR (1989) Ocular lubricants and corneal injury during anesthesia. Anesth Analg 69:384–385

    CAS  PubMed  Google Scholar 

  23. 23.

    White E, Crosse MM (1998) The aetiology and prevention of peri-operative corneal abrasions. Anaesthesia 53:157–161

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Ellis P, Fraunfelder F (1999) Ophthalamic therapeutics. In: Vaughan D, Asbury T, Riordan-Eva P (ed) General ophthalmology. Appleton and Lange, Stamford, Conneticut, pp 57–73

  25. 25.

    Jaanus S (1984) Lubricant preparations. In: Bartlett J, Jaanus S (ed) Clinical ocular pharmacology. Butterworth, London, pp 287–297

  26. 26.

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

    CAS  PubMed  Google Scholar 

  27. 27.

    Suresh P, Mercieca F, Morton A, Tullo AB (2000) Eye care for the critically ill. Intensive Care Med 26:162–166

    CAS  PubMed  Google Scholar 

  28. 28.

    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  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Queensland Nursing Council’s Research Grant. The views expressed do not necessarily represent the views of the Council or the members, executive officer or staff of the Council. We thank the Medical and Nursing staff of the Royal Brisbane Hospital, Department of Intensive Care Medicine.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jeff Lipman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Koroloff, N., Boots, R., Lipman, J. et al. 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 (2004). https://doi.org/10.1007/s00134-004-2203-y

Download citation

Keywords

  • Clinical nursing research
  • Critical care
  • Eye
  • Epithelium
  • Corneal