• Itai Bendavid, Inbal Avisar, Irena Serov Volach, Amir Sternfeld, Idit Dan Brazis, Lewaa Umar, Yiftach Yassur, Pierre Singer, and Jonathan David Cohen.
• 1Department of General Intensive Care, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel. 2Department of Opthalmology, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel. 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
• Crit. Care Med. 2017 Nov 1; 45 (11): 1880-1886.

ObjectivesTo compare the effectiveness of bandage contact lenses and punctal plugs with ocular lubricants in preventing corneal damage in mechanically ventilated and sedated critically ill patients.DesignSingle-center, prospective, randomized, pilot study.SettingSixteen-bed, general ICU at a tertiary academic medical center.PatientsAdults admitted to the ICU and anticipated to require mechanical ventilation and continuous sedation for greater than or equal to 4 days.InterventionsPatients were randomized to receive eye care with ocular lubricants (n = 38), bandage contact lenses (n = 33), or punctal plugs (n = 33). The bandage contact lenses were changed every 4 days, whereas the punctal plugs remained in situ for the entire study.Measurements And Main ResultsThe primary endpoint was the presence or absence of corneal damage as assessed by the grade of keratopathy. Patients were examined by an ophthalmologist blinded to the study group every 4 days and at the time of withdrawal from the study, due to cessation of sedation, discharge from the ICU, or death. The mean duration of the study was 8.6 ± 6.2 days. The grade of keratopathy in the ocular lubricant group increased significantly in both eyes (p = 0.01 for both eyes) while no worsening was noted in either the lens or punctal plugs groups. In a post hoc analysis of patients with an initially abnormal ophthalmic examination, significant healing of keratopathy was noted in the lens group (p = 0.02 and 0.018 for left and right eyes, respectively) and in the right eye of the plugs group (p = 0.005); no improvement was noted in the ocular lubricant group.ConclusionsCompared with ocular lubrication, bandage contact lenses and punctal plugs were more effective in limiting keratopathy, and their use, particularly of bandage contact lenses, was associated with significant healing of existing lesions.

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