Eye Care for Intensive Care Patients

Waida, in her aim of getting good grades, is spending her Saturday night studying for next week’s discussion about eye care. She’s scanning through an article when she reads that patients in critical care settings are at increased risk for developing eye complications. Well, if that’s the case then, what are some interventions nurses should take to address this? What are certain eye care procedures needed for intensive care patients?

Preventing eye complications with eye care measures

Patients in critical care settings, they say, are at increased risk for developing ocular complications which are usually results of excessive exposure and drying of the surface of the eye. However, with proper, simple eye care measures, the incidence of sight-threatening infections and scarring that can yield long-term problems may be decreased. As for patients who are terminally ill, proper eyecare will help preserve the health of the corneal tissue and as well as the option of eye donation for the patient or the patient’s family members. Below are some interventions nurses may take to provide proper eye care to their ICU patients.

  • Assessment of a critical care patient’s eyes should routinely be done by each nursing shift. Check the eyes of patients who are not sedated and ventilated to gain an appreciation of the normal appearance of the eye.
  • Assess eyelid position carefully. Using a penlight or flashlight will help reveal poor lid closure, which might be masked by the eyelashes.
  • In a sedated patient with seemingly closed eyes, the upper eyelids should be manually elevated to allow inspection of the cornea. A piece of gauze helps with manual traction of the eyelids if they are oily. Does the tear film appear uniform or is the light reflection irregular?
  • Sterile saline may be used to rinse away any mucus or lubricant ointment, thus allowing better assessment of the corneal surface.
  • Any patient with signs of exposure keratopathy, lagophthalmos, or a decreased blink rate (normal blinking occurs every 5-10 seconds) should be treated every 4-6 hours with an ocular lubricating ointment such as Lacrilube.Ointments moisturize the ocular surface more effectively than drops.
  • The ointment should be placed along the internal surface of the lower eyelid. The lids should then be manually closed to spread the ointment over the ocular surface. Once again, if any whitish corneal lesions or purulent discharge develops prompt ophthalmologic consultation is indicated to rule out corneal infection. A small amount of non-purulent mucous buildup is common in cases of exposure keratopathy.
  • In cases of significant exposure, whether from decreased blinking or poor lid closure, lubricant ointment should be applied every 4 hours. Prolapsed, chemotic conjunctiva can further worsen the exposure problems.
  • In addition to lubricant ointment, polyethylene moisture chamber (i.e. Saran Wrap) may be placed over the skin in a strip from temple to temple, wide enough to cover the lower forehead, bridge of the nose, and upper cheeks. This will create a “moisture chamber” over the eyes.
  • A small amount of petroleum jelly on the skin of the brow, temples and cheeks will create a tighter seal by the cling wrap, but still allow easy removal for inspection and application of ointment. The cling wrap should be changed each shift to lessen the risk of infection.
  • Visitors to the patient should be briefed on the need for the cling wrap to avoid any undue alarm.

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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