Keywords
Intensive Care Unit
Nursing Practice
Ocular Surface Diseases
OSD
Rapid Review
How to Cite
Abstract
Introduction. Ocular Surface Diseases (OSDs) are frequent yet often under-recognised complications in sedated and mechanically ventilated Intensive Care Unit (ICU) patients, in whom impaired eyelid closure and reduced tear film protection promote their development during critical illness. Although these conditions can significantly affect visual function and post-discharge quality of life, ocular care receives inconsistent attention in routine clinical practice. This rapid review aimed to identify and synthesise evidence-based nursing practices for the prevention and management of OSDs in the ICU within this patient population.
Methods. A rapid review was conducted between February and August 2024 and registered in PROSPERO (CRD42024540825). Searches were carried out in MEDLINE, CINAHL, Embase, and Google Scholar for full-text studies published in English between 2014 and 2024 that involved adult ICU patients receiving nurse-delivered ocular interventions. Methodological quality was appraised using the Joanna Briggs Institute critical appraisal tools. Given the heterogeneity of study designs and outcomes, a narrative synthesis was undertaken.
Results. Fourteen studies (n = 1,322 patients) from six countries met the inclusion criteria; most were randomised controlled trials (64%), and 72% were rated as having high methodological quality. Interventions included the application of preservative-free lubricants, vitamin A–based ointments, moisture chambers, polyethylene covers, eyelid taping, and structured nurse-led protocols. Moisture chambers and ointments demonstrated the strongest protective effects against exposure keratopathy, while the implementation of protocols and targeted nurse education significantly reduced ocular morbidity.
Discussion. The findings reaffirm the central role of ICU nurses in preventing OSDs through timely, evidence-based interventions. Standardising eye care practices may substantially reduce complications and enhance long-term visual outcomes. Further high-quality multicentre studies are required to refine recommendations and support broader clinical implementation.
References
Ahmadinejad M, Karbasi E, Jahani Y, Ahmadipour M, Soltaninejad M, Karzari Z. (2020). Efficacy of simple eye ointment, polyethylene cover, and eyelid taping in prevention of ocular surface disorders in critically ill patients: a randomized clinical trial. Crit Care Res Pract. 2020;2020:6267432. https://doi:10.1155/2020/6267432.
Alansari MA, Hijazi MH, Maghrabi KA. (2015). Making a difference in eye care of the critically ill patients. J Intensive Care Med. 2015;30(6):311–7. https://doi:10.1177/0885066613510674.
Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. (2015). Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132–40. https://doi:10.1097/XEB.0000000000000055.
Babamohamadi H, Nobahar M, Razi J, Ghorbani R. (2018). Comparing vitamin A and moist chamber in preventing ocular surface disorders. Clin Nurs Res. 2018;27(6):714–29. https://doi:10.1177/1054773817695618.
Badparva M, Veshagh M, Khosravi F, Mardani A, Ebrahimi H. (2021). Effectiveness of lubratex and vitamin A on ocular surface disorders in ICU patients: a randomized clinical trial. J Intensive Care Soc. 2021;22(2):136–42. https://doi:10.1177/1751143720912697.
Cellura L, Scaglia SG, Longo S, Cesari M, Arioli R, Meda G, et al. (2025). Eye care practice in intensive care units: a rapid review. Preprints. 2025;2025070671. https://doi:10.20944/preprints202507.0671.v1.
Demirel S, Cumurcu T, Fırat P, Aydogan MS, Doğanay S. (2014). Effective management of exposure keratopathy developed in intensive care units: the impact of an evidence-based eye care education programme. Intensive Crit Care Nurs. 2014;30(1):38–44. https://doi:10.1016/j.iccn.2013.08.001.
Dhanapala M, Sabaretnam S. (2021). Audit of eye care for ventilated patients in intensive treatment unit during COVID-19 pandemic. Sri Lankan J Anaesthesiol. 2021;29(1):n.p. https://doi:10.4038/slja.v29i1.8755.
Frazee EN, Personett HA, Bauer SR, Dierkhising RA, Kashyap R, Zubair AS, et al. (2015). Intensive care nurses’ knowledge about use of neuromuscular blocking agents in patients with respiratory failure. Am J Crit Care. 2015;24(5):431–9. https://doi:10.4037/ajcc2015397.
Grixti A, Sadri M, Watts MT. (2013). Corneal protection during general anesthesia for nonocular surgery. Ocul Surf. 2013;11(2):109–18. https://doi:10.1016/j.jtos.2012.10.003.
Hearne BJ, Hearne EG, Montgomery H, Lightman SL. (2018). Eye care in the intensive care unit. J Intensive Care Soc. 2018;19(4):345–50. https://doi:10.1177/1751143718764529.
Hernandez EV, Mannis MJ. (1997). Superficial keratopathy in intensive care unit patients. Am J Ophthalmol. 1997;124(2):212–6. https://doi:10.1016/s0002-9394(14)70786-x.
Imanaka H, Taenaka N, Nakamura J, Aoyama K, Hosotani H. (1997). Ocular surface disorders in the critically ill. Anesth Analg. 1997;85(2):343–6. https://doi:10.1097/00000539-199708000-00018.
Jammal H, Khader Y, Shihadeh W, Ababneh L, Aljizawi G, AlQasem A. (2012). Exposure keratopathy in sedated and ventilated patients. J Crit Care. 2012;27(6):537–41. https://doi:10.1016/j.jcrc.2012.02.005.
Kalhori RP, Ehsani S, Daneshgar F, Ashtarian H, Rezaei M. (2015). Different nursing care methods for prevention of keratopathy among intensive care unit patients. Glob J Health Sci. 2015;8(7):212–7. https://doi:10.5539/gjhs.v8n7p212.
Kousha O, Kousha Z, Paddle J. (2018). Exposure keratopathy: incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults. J Crit Care. 2018;44:413–8. https://doi:10.1016/j.jcrc.2017.11.031.
Kuruvilla S, Peter JV, David S, Premkumar PS, Ramakrishna K, Chacko B, et al. (2015). Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: a cohort study. J Crit Care. 2015;30(2):400–4. https://doi:10.1016/j.jcrc.2014.10.009.
Langlois EV, Straus SE, Antony J, King VJ, Tricco AC. (2019). Using rapid reviews to strengthen health policy and systems and progress towards universal health coverage. BMJ Glob Health. 2019;4(1):e001178. https://doi:10.1136/bmjgh-2018-001178.
Lightman S, Montgomery H. (2020). Ophthalmic services guidance: eye care in the intensive care unit (ICU). London: Royal College of Ophthalmologists; 2020. Available from: https://www.rcophth.ac.uk/wp-content/uploads/2021/01/Eye-Care-in-the-Intensive-Care-Unit-2020.pdf [accessed 2024 Jul 23].
Masoudi AN, Sharifitabar Z, Shaeri M, Adib Hajbaghery M. (2014). An audit of eye dryness and corneal abrasion in ICU patients in Iran. Nurs Crit Care. 2014;19(2):73–7. https://doi:10.1111/nicc.12052.
McHugh J, Alexander P, Kalhoro A, Ionides A. (2008). Screening for ocular surface disease in the intensive care unit. Eye (Lond). 2008;22(12):1465–8. https://doi:10.1038/sj.eye.6702930.
Mercieca F, Suresh P, Morton A, Tullo A. (1999). Ocular surface disease in intensive care unit patients. Eye (Lond). 1999;13(Pt 2):231–6. https://doi:10.1038/eye.1999.57.
Mobarez F, Sayadi N, Jahani S, Sharhani A, Savaie M, Farrahi F. (2022). The effect of eye care protocol on the prevention of ocular surface disorders in patients admitted to intensive care unit. J Med Life. 2022;15(8):1000–4. https://doi:10.25122/jml-2022-0139.
NSW Agency for Clinical Innovation. (2024). Eye care of the critically ill: clinical practice guide. Sydney: ACI; 2024. Available from: https://aci.health.nsw.gov.au/data/assets/pdf_file/0007/239731/ACI-Eye-Care-of-the-Critically-Ill-Clinical-Practice-Guide.pdf [accessed 2024 Jul 7].
Nikseresht T, Rezaei M, Khatony A. (2021). The effect of three eye care methods on the severity of lagophthalmos in intensive care patients: a randomized controlled clinical trial. J Ophthalmol. 2021;2021:6348987. https://doi:10.1155/2021/6348987.
Ousler GW 3rd, Hagberg KW, Schindelar M, Welch D, Abelson MB. (2008). The ocular protection index. Cornea. 2008;27(5):509–13. https://doi:10.1097/ICO.0b013e31816583f6.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. (2016). Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. https://doi:10.1186/s13643-016-0384-4.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. (2020). Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021;134:103–12. https://doi:10.1016/j.jclinepi.2021.02.003.
Rosenberg JB, Eisen LA. (2008). Eye care in the intensive care unit: narrative review and meta-analysis. Crit Care Med. 2008;36(12):3151–5. https://doi:10.1097/CCM.0b013e31818f0ee7.
Sanghi P, Malik M, Hossain IT, Manzouri B. (2021). Ocular complications in the prone position in the critical care setting: the COVID-19 pandemic. J Intensive Care Med. 2021;36(3):361–72. https://doi:10.1177/0885066620959031.
Saritas TB, Bozkurt B, Simsek B, Cakmak Z, Ozdemir M, Yosunkaya A. (2013). Ocular surface disorders in intensive care unit patients. Scientific W J. 2013;2013:182038. https://doi:10.1155/2013/182038.
Sorce LR, Hamilton SM, Gauvreau K, Mets MB, McManus ML, Darras BT, et al. (2011). Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: a randomized, controlled trial. Pediatr Crit Care Med. 2011;10(2):171–5. https://doi:10.1097/PCC.0b013e3181956ccf.
Tricco AC, Langlois EV, Straus SE, editors. (2017). Rapid reviews to strengthen health policy and systems: a practical guide. Geneva: World Health Organization; 2017. Available from: https://iris.who.int/handle/10665/258698 [accessed 2024 Feb 3].
Vyas S, Mahobia A, Bawankure S. (2018). Knowledge and practice patterns of intensive care unit nurses towards eye care in Chhattisgarh state. Indian J Ophthalmol. 2018;66(9):1251–5. https://doi:10.4103/ijo.IJO_115_18.
Werli-Alvarenga A, Ercole FF, Botoni FA, Oliveira JA, Chianca TCM. (2011). Corneal injuries: incidence and risk factors in the intensive care unit. Rev Latino-Am Enfermagem. 2011;19(5):1088–95. https://doi:10.1590/S0104-11692011000500005.
Yu XY, Xue LY, Zhou Y, Shen J, Yin L. (2021). Management of corneal ulceration with a moisture chamber due to temporary lagophthalmos in a brain injury patient: a case report. World J Clin Cases. 2021;9(5):1127–31. https://doi:10.12998/wjcc.v9.i5.1127.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 © The Author(s) 2025.