Imanaka H, Taenaka N, Nakamura J, Aoyama K, Hosotani H
Intensive Care Unit, Osaka University Hospital, Japan.
Anesth Analg. 1997 Aug;85(2):343-6. doi: 10.1097/00000539-199708000-00018.
Abnormalities of the cornea and conjunctiva occur in association with neurological diseases, nocturnal lagophthalmos, coma, infection, and mechanical ventilation. We investigated the incidence and causes of ocular surface disorders in critically ill patients. In a retrospective study, the presence of conjunctivitis and corneal erosion was determined by reviewing the medical charts of 143 mechanically ventilated patients (intensive care unit [ICU] stay > or =7 days). In the subsequent prospective study, 15 patients who had sedatives or muscle relaxants administered continuously for more than 48 h in the ICU were investigated. Corneal erosion was examined using a slit lamp once a day. Ocular surface disorder was found in 28 of the 143 patients (20%) whose ICU stay exceeded 7 days. The incidence increased with continuous sedation (35% vs 15%). The incidence also increased with continuous neuromuscular blockade (39% vs 11%). In the prospective study, nine patients (60%) developed corneal erosion. A patient's inability to fully close his or her eyes increased the incidence (P < 0.01) of corneal erosion. Protective eyelid taping was effective in preventing and treating the corneal erosion. In conclusion, the critically ill often develop ocular surface disorders, especially when sedated and immobilized. A close relationship was observed between these conditions and the inability to close one's eyes.
角膜和结膜异常与神经疾病、夜间兔眼症、昏迷、感染及机械通气相关。我们调查了重症患者眼表疾病的发生率及病因。在一项回顾性研究中，通过查阅143例机械通气患者（重症监护病房[ICU]住院时间≥7天）的病历确定结膜炎和角膜糜烂的情况。在随后的前瞻性研究中，对15例在ICU连续使用镇静剂或肌肉松弛剂超过48小时的患者进行了调查。每天用裂隙灯检查角膜糜烂情况。在143例ICU住院时间超过7天的患者中，有28例（20%）发现眼表疾病。连续镇静时发病率增加（35%对15%）。连续使用神经肌肉阻滞剂时发病率也增加（39%对11%）。在前瞻性研究中，9例患者（60%）发生角膜糜烂。患者不能完全闭眼会增加角膜糜烂的发病率（P<0.01）。保护性眼睑贴扎对预防和治疗角膜糜烂有效。总之，重症患者常发生眼表疾病，尤其是在使用镇静剂和制动时。观察到这些情况与不能闭眼之间存在密切关系。
