Risk Factors for the Development of Inpatient Exposure Keratitis

Abstract

Purpose: To identify the risk factors for inpatient exposure keratitis and make possible the development of improved educational tools for providers. Methods: Retrospective chart review of inpatient ophthalmology consults at a major New York City teaching hospital, identifying patients with exposure keratitis. Patients included were seen by the ophthalmology consult service over a 3 year period and had exposure keratitis severe enough to require active treatment. Results: The four most common risk factors were sedation and mechanical ventilation (22/61, 36%), facial nerve palsy (10/61, 16%), nocturnal lagophthalmos (7/61,11%) and cicatricial or post-surgical lid changes (5/61,8%).Inpatient location was identifiable in 59 cases. 31% (18/59) of cases came from the physical therapy and rehabilitation floors and 24% (14/59) from the intensive care units. There were significantly more exposure keratitis cases identified during the 1st Half of the Academic Year, July through December, (45/61,74%) than the 2nd Half of the Academic year, January through June. (16/61, 26%) [P=0.03]. Conclusions: Sedation and mechanical ventilation, facial nerve palsy, nocturnal lagophthalmos, and cicatricial or post-surgical lid changes are the most common risk factors for inpatient exposure keratitis. Further study of the role of the primary team in preventing exposure keratitis is needed, and comprehensive efforts should be undertaken to reduce the incidence of this disease.