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ORIGINAL ARTICLE
Year : 2020  |  Volume : 12  |  Issue : 2  |  Page : 43-45

Eye care in the intensive care unit for COVID-19 patients


1 Department of Ophthalmology, Sohag University, Sohag, Egypt
2 Department of Anesthesia and Intensive Care Unit, Sohag University, Sohag, Egypt

Date of Submission20-Jul-2020
Date of Decision19-Aug-2020
Date of Acceptance08-Sep-2020
Date of Web Publication09-Mar-2021

Correspondence Address:
Dr. Hany Mahmoud
Department of Ophthalmology, Sohag University, Sohag
Egypt
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DOI: 10.4103/sjopthal.sjopthal_17_20

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  Abstract 

Purpose: To assess eye manifestations and ensure the importance of eye care for COVID-19 patients in the intensive care unit, they need regular ophthalmological examination and follow-up. Patients and Methods: In this case series study, 43 patients' (86) eyes with COVID-19 were included in the study. The ocular history was taken from hospital-registered data. They were ophthalmologically examined using a portable slit lamp or by a by-side examination (diffuse illumination), and the anterior segment was evaluated. Schirmer's test was done for all patients to assess dryness. A Tono-Pen™ Tonometer was used in all cases to measure intraocular pressure with full infection control measures. Results: Sixteen (18.6) per cent of eyes were affected either by dryness due to exposure, infection (mucopurulent conjunctivitis), and subconjunctival hemorrhage with no apparent vision affection, and two were on antiglaucoma medications before the infection and advised to continue their medication. Conclusion: Eye care is mandatory for patients in ICU with COVID-19.

Keywords: COVID-19, eye care, intensive care unit


How to cite this article:
Mahmoud H, Hamody A. Eye care in the intensive care unit for COVID-19 patients. Sudanese J Ophthalmol 2020;12:43-5

How to cite this URL:
Mahmoud H, Hamody A. Eye care in the intensive care unit for COVID-19 patients. Sudanese J Ophthalmol [serial online] 2020 [cited 2021 Apr 19];12:43-5. Available from: https://www.sjopthal.net/text.asp?2020/12/2/43/311041


  Introduction Top


The emergence of severe acute respiratory syndrome (SARS) in 2019 and its global spread,[1] with the massive need for intensive care units (ICUs), created a great load on the health systems in many countries.[2] The admitted patients in the ICU need oxygenation either noninvasive or by intubation; they are in a prone position with decreased consciousness level according to the Glasgow Coma Scale (GCS). This has a negative effect on the eyes of admitted patients either due to muscle relaxant given in ICU,[3] exposure of the eye, infection, or neglect of ocular diseases such as glaucoma.

The mask used releases oxygen to the eyes, increasing the possibility of dryness.[4] Lifesaving is more important than organ saving; therefore, in some cases, eye protection is unintentionally neglected, that is, because of the stress in the ICU and lack of collaboration with ophthalmologists.

Many conjunctival manifestations were observed with COVID-19 such as infection, subconjunctival hemorrhage, and follicular conjunctivitis.[5] Conjunctivitis could be the sole alarming manifestation of COVID-19.[6] Recent studies have evaluated the presence of SARS-Co-2 RNA in tears and conjunctival secretions.[7]

Aim of the study

To screen for eye problems in ICU-admitted patients with positive COVID-19 and ensure the importance of eye care for COVID-19 patients in ICU, they need regular ophthalmological examination and follow-up.

This study was done in Sohag Tropical Hospital in collaboration with Sohag University Hospital in the period from June 1, 2020, to June 30, 2020.

Ethical considerations

Full ethical considerations were followed, and comprehensive written informed consent was obtained from all involved patients or their relatives in this study. Our study adhered to the tenants of the Helsinki Declaration, and the ethical board committee approval of our institution (Sohag Faculty of Medicine) was obtained. This study did not include children, and only adult patients were included in the study.


  Patients and Methods Top


In this case series study, all admitted patients to ICU in our hospital in the period from June 1, 2020, to June 30, 2020, were included in the study.

Exclusion criteria were patients under 18 years of age.

Eighty-six eyes of 43 patients admitted to the ICU; the ocular history before COVID-19 infection was taken from registered data in the hospital.

They were examined mainly by by-side examination with diffuse illumination. A portable slit lamb was used when available. A brief ophthalmological history was taken from the patients or their relatives. The external appearance of the eyes was examined with the position of the upper eyelids, conjunctiva, and cornea.

Schirmer's test was done to all patients to assess the degree of eye dryness if present.

We measured the intraocular pressure (IOP) using a Tono-Pen™ Tonometer in all patients with a history of glaucoma.

Data were collected and analyzed.


  Results Top


The 43 patients were with different degrees of GCS as shown in [Table 1].
Table 1: Forty-three patients were with different degrees of Glasgow Coma Scale

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We found that 86 eyes were examined. Of these, three (3.48%) had dryness due to exposure, and all of them had mild-to-moderate degree of dryness according to Schirmer's test. According to the ocular recorded data, these patients had not any element or risk factor for dry eye before [Figure 1], five (5.81%) had an infection (mucopurulent conjunctivitis) the cause of infection could be the exposure, the infection spreaded in some cases to the other eyes [Figure 2], six (6.97%) showed subconjunctival hemorrhage with no apparent affection of vision [Figure 3], and two (2.32%) were prescribed antiglaucoma medications before the infection and advised to continue their medication. The average IOP was 23 mmHg and became 18 mmHg after antiglaucoma reintroduction. [Table 2] shows the ocular findings of the patients.
Figure 1: Dry eye by the Schemer's test due to exposure

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Figure 2: Unilateral mucopurulent conjunctivitis on treatment

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Figure 3: Subconjunctival hemorrhage

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Table 2: Ocular findings of the patients

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Patients with dry eye were treated with tear substitutes with prophylactic antibiotics to avoid infections. We used eye ointment antibiotics at night with eye patches. Patients with infection antibiotic eye drops and ointments were sufficient with eye care with hot fomentations if applicable, patients with subconjunctival hemorrhage treated with tear substitutes and prophylactic antibiotics, and patients who were on antiglaucoma were advised to continue their medications with IOP measurement with Tono-Pen Tonometer.


  Discussion Top


The study showed that patients with COVID-19 in the ICU suffer from many ocular problems such as dry eye, which is due to exposure of the eye, oxygen flow, and prone position. It can be easily measured using Schirmer's test.[8] Forcible breathing and straining during cough can cause severe subconjunctival hemorrhage.[5] This subconjunctival hemorrhage does not affect the vision of the patients.

The eyes with infections due to exposure and poor hygiene in some cases were treated with strong antibiotic eye drops. We preferred to give tear substitutes to all patients to avoid irritation from exposure.[9]

We faced patients who were on antiglaucoma medications after consultation of ICU specialist; we advised them to continue their medications and measure IOP by Tono-Pen™ Tonometer.

In this study, we compared the eye manifestations of the patients before admission to the ICU, and after admission, the ocular manifestations developed after guarantee.

Our results correlate with the Stafford study in Moorfields Eye Hospital, London,[10] which discusses the ocular problems in patients admitted in ICU and their management.


  Conclusion Top


evaluation of the eyes is mandatory to patients in ICU.

Limitations

The strict infection control measures and the difficulty in imaging patients in ICU could be an obstacle rather than the conscious level of some patients, which limit the possibility of proper visual acuity measurement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.  Back to cited text no. 1
    
2.
Ñamendys-Silva SA. Respiratory support for patients with COVID-19 infection. Lancet Respir Med 2020;8:e18.  Back to cited text no. 2
    
3.
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574-81.  Back to cited text no. 3
    
4.
Uchino M, Yokoi N, Uchino Y, Dogru M, Kawashima M, Komuro A, et al. Prevalence of dry eye disease and its risk factors in visual display terminal users: the Osaka study. Am J Ophthalmol 2013;156:759-66.  Back to cited text no. 4
    
5.
Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol 2020;138:575-8.  Back to cited text no. 5
    
6.
Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol 2020;104:748-51.  Back to cited text no. 6
    
7.
Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020;92:589-94.  Back to cited text no. 7
    
8.
de Araújo DD, Almeida NG, Silva PM, Ribeiro NS, Werli-Alvarenga A, Chianca TC. Prediction of risk and incidence of dry eye in critical patients. Rev Lat Am Enfermagem 2016;24:e2689.  Back to cited text no. 8
    
9.
Singh P, Müller M, Hack D, Kempf VAJ, Wicker S, König C, et al. Development and implementation of an operational concept in a university eye hospital in the SARS-CoV-2 pandemic. Ophthalmologe 2020;117:595-601.  Back to cited text no. 9
    
10.
Sansome SG, Lin PF. Eye care in the intensive care unit during the COVID-19 pandemic. Br J Hosp Med (Lond) 2020;81:1-0.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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