key: cord-0874919-k94874pa
authors: Myint, Katie; Lee, Dillan; Pringle, Edward
title: Comment on: “Care for critically ill patients with COVID-19: don’t forget the eyes”
date: 2020-07-13
journal: Eye (Lond)
DOI: 10.1038/s41433-020-1079-6
sha: 91c40b7ef79445a9d0e27e5ef9426730b450c151
doc_id: 874919
cord_uid: k94874pa

nan

Ting et al. [1] recognized that prevention of exposure keratopathy is paramount in critically ill patients with COVID-19. We agree, particularly as the COVID-19 patients who require mechanical ventilation and sedation tend to have longer stays in critical care, which increases their risk of developing exposure keratopathy. However, eye care may be overlooked in busy critical care units under strain during this pandemic. Using guidelines from the Royal College of Ophthalmologists [2] , we audited our experience (see Table 1 ).

We found 51% of COVID-19 patients in critical care had some degree of eye exposure due to incomplete lid closure (lagophthalmos) in our first audit. Only a third of these patients had adequate lubrication, and less than a quarter with severe exposure (grade 2: cornea visible) had any form of assisted lid closure. Those who needed to be nursed 'proned' fared slightly better in eye treatment; perhaps by virtue of being sicker with COVID-19, these patients were seen to more attentively.

Whilst redeployed from our eye departments to critical care, we instituted an eye teaching program in the intensive care unit, with a simple message:

Open eyes ¼ Ointment Following our teaching, our re-audit data showed nearly 90% of COVID-19 patients in critical care with lagophthalmos had adequate lubrication, including those with severe exposure. However, there was still room for improvement regarding assisted lid closure. Therefore, we repeated a teaching session with a new message: Iris ½ Colour seen ¼ Close the lid tape; gel pad or suture ½ COVID-19 is a cruel illness; we have seen its devastating effect on patients, and the strain on healthcare services. We must ensure that patients who recover from COVID-19 do not On reflection, redeployment has been an enriching experience, throughout which we have felt supported and valued by our colleagues. If there is a 'second wave' of COVID-19 as predicted, we are optimistic that the healthcare community will continue to show adaptability, teamwork and resilience for the benefit of our patients.

Conflict of interest The authors declare that they have no conflict of interest.

Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Care for critically ill patients with COVID-19: don't forget the eyes

Eye care in the intensive care unit (ICU)