Characteristics and associated risk factors of exposure keratopathy among ventilated patients in intensive care units in Jordan

Background: Exposure keratopathy is the most common ocular surface disorder in ventilated patients due to poor eyelid closure, decreased blink reflex, and the inability to produce tears. Healthcare providers in intensive care units (ICUs) play a significant role in preventing exposure keratopathy through appropriate eyelid taping and eye ointments. Methods: This is a cross-sectional study to describe the characteristics and factors associated with exposure keratopathy in all mechanically ventilated patients admitted to an adult ICU between February and June 2023. Patients were examined for corneal changes using a corneal fluorescein staining test with a cobalt blue filter indirect ophthalmoscope. Results: Of 156 ventilated patients included in this study, 42.3% had exposure keratopathy, 13.5% had lagophthalmos, and 26.9% of patients had chemosis. For patients with a Glasgow Coma Scale (GCS) score of 3, the odds ratio of exposure keratopathy was 21.47 (95% confidence interval [CI], 2.82-163.05). The use of inotropes increased the odds ratio to 35.55 (95% CI, 3.41-369.90), whereas a hospital stay >7.23 days increased the odds ratio to 43.59 (95% CI, 15.66-1,316.32). Conclusions: The frequency of exposure keratopathy is high and is underestimated in ventilated patients, with lower GCS and increased hospital length of stay as the main risk factors. Prioritizing eye care in ventilated patients with low GCS scores or prolonged ICU stays is essential to reduce exposure keratopathy.