Early detection of ocular lesions in critically ill children: Testing an ocular assessment scale

Abstract

Objective: There is scarcity of data on the incidence and factors associated with the occurrence of ocular lesions in critically ill children. The objective was to test the applicability and utility of an ocular assessment scale and to identify risk factors of ocular lesions.

Design: Prospective observational study.

Setting: A tertiary care medical-surgical Paediatric Intensive Care Unit.

Sample: 194 children without previous ocular disease who stayed in the Paediatric Intensive Care Unit for more than 48 h.

Interventions: An ocular lesions risk scale was designed including risk factors lagophthalmos, eye dryness, conjunctival hyperemia, slow blinking, intubation, sedation, relaxation, face mask and hemodynamic instability. Patients were classified as high-, medium-, and low-risk patients. Corneal lesions were examined by fluorescein staining according to their risk and were confirmed by an ophthalmologist.

Results: 76 patients were examined with fluorescein staining. Thirty-two ocular lesions were detected by nursing staff, 26 confirmed by the ophthalmologist. 53.6% of the high-risk patients developed a corneal lesion. Univariate analysis revealed an association between ocular damage and all factors included in the scale, except for face mask. In the multivariate analysis, ocular lesions were associated with lagophthalmos, hyperemia, invasive mechanical ventilation and inotropic support.

Conclusions: The scale was useful to detect corneal lesions in critically ill children. The identification of risk factors will enable the development of measures to reduce the incidence of ocular lesions.

Relevance for clinical practice: A new, non-validated scale allowed staff to detect eye injuries, study this problem and improve future prevention.