Eye changes in the intensive care unit: a cohort study



Queila Faria dos Santos1, Grasciele Oroski Paes1

1 Federal University of Rio de Janeiro



Aims: identify risk factors significantly associated with corneal injury in intensive care unit patients; estimate the recurrence of risk factors associated with corneal injury in intensive care unit patients; propose a logistics regression model capable of estimating the risk of corneal injury in intensive care unit patients. Method: This is a prospective cohort study conducted in a private network hospital located in the state of Rio de Janeiro with patients in the intensive care unit, using an instrument, and participants will be evaluated using the Fluorescein 1% test. The data will be processed by the Statistical Package for the Social Sciences, version 22.0 and by the Microsoft Excel 2007 application. The main tests applied will be Chi-square Test, Fisher's Exact Test, Kolmogorov-Smirnov and Shapiro-Wilk. The logistic regression analysis will be performed.

Descriptors: Corneal Injuries; Dry eye syndromes; Intensive care units.




The dynamics of the intensive care environment may lead to prioritization of immediate and complex care for critically ill patients over other basic but essential care1. In this directive, scientific evidence has proven that procedures considered of low complexity are placed in the background due to the high technology linked to the care practice in the Intensive Care Unit (ICU)1.

The mechanisms responsible for lubrication and eye protection may be compromised in critically ill patients. Eye exposure is the most relevant cause of corneal injury2. There are many factors that can trigger the reduction of the patient's eye defense mechanisms and lubrication in the intensive care environment1,3.

Eye care is a simple and effective strategy in the prevention of eye complications3. Therefore, early clinical judgment becomes a determining factor in nursing care to prevent and identify early eye changes. However, a body of knowledge about the main eye alterations and risk factors of the patient in the ICU is necessary to reduce ophthalmic damage to a minimum, as they are events that can be prevented1,2.

Based on the problem situation presented, the research aims to identify risk factors significantly associated with corneal injury in intensive care patients; to estimate the recurrence of factors associated with risk of corneal injury in intensive care patients; to propose a logistic regression model capable of estimating the risk of corneal injury in ICU patients.




This is a quantitative, epidemiological, observational prospective cohort type survey. The research field is a private network hospital with a Joint Commission International (JCI) accreditation seal of excellence. The intensive care unit is composed of 18 active beds arranged in two intensive care units. To compose the research sample the following eligibility criteria will be used: patients over 18 years of age admitted to the ICU during the data collection period that do not present previous corneal injury, which will be verified by the Fluorescein sodium 1% test, and who agree to participate in the study by signing the free and informed consent form. After the sample calculation, the estimated casuistry for this work was 77 patients. The evaluation instrument includes: sociodemographic data, clinical data, ocular alterations, factors associated with the risk of corneal injury and the Fluorescein 1% test. The preparation of this instrument is based on previous studies in the current literature.

The cornea of the participants will be evaluated daily by a nurse trained by an ophthalmologist, who will instill a drop of fluorescein in each eye and, after three minutes, will perform the evaluation with the aid of a cobalt light ophthalmoscope and record the data in the data collection instrument. If the participants present cells that have been de-epitalized, they will be removed from the research and the team on duty will be notified so that the appropriate measures can be instituted. The data will be processed by the Statistical Package for the Sciences (SPSS) program. The descriptive analysis will be done by calculating the mean, median, standard deviation, coefficient of variation, correlation coefficient, proportions, and risk measures (odds ratio and relative risk). In the inferential analysis, the tests applied will be the chi-square test, Fisher's Exact, Kolmogorov-Smirnov, Shapiro-Wilk, Student's t, Mann-Whitney, ANOVA, and Kruskall Wallis. To evaluate the relationship between variables associated with corneal injury, the logistic regression analysis will be performed.

Through ethical-legal issues, referred by the National Health Council, this study was approved by the Research Ethics Committee of the Anna Nery School of Nursing and the hospital where the research was held under CAAE: 13942519.0.0000.5238.





  1. 1. Oliveira R, Fernandes A, Botarelli F, Araújo J, Barreto V, Vitor A. Fatores de risco para lesão de córnea em pacientes criticos na terapia intensiva: uma revisão integrativa Risk factors for injury in thecornea in criticalpatients in intensivecare: anintegrative review. Rev Pesq: Cuidado Fundam Online [Internet]. 2016 Apr [cited 2020 Mar 12]; 8(2): 4423-4434. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/4592 .


    2. Pitombeira DO, Souza ÂML, Fernandes APNL, Araújo JNM, Silva AB, Vitor AF. Características dos pacientes com ressecamento ocular internados em unidade de terapia intensiva. Cogitare Enferm [Internet]. 2018 [cited 2020 Mar 12];23(2). Available from: http://dx.doi.org/10.5380/ce.v23i2.53081 .


    3. Freitas LS, Ferreira MA, Almeida Filho AJ, Santos CCG, Silva LB. Lesões na córnea em usuários sob os cuidados intensivos: contribuições à sistematização da assistência de enfermagem e segurança do paciente. Texto Contexto Enferm  [Internet]. 2018  [cited 2020  Abr  25]; 27(4): e4960017. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010407072018000400311&lng=pt .  Epub 01-Nov-2018.https://doi.org/10.1590/0104-07072018004960017 .




All authors participated in the phases of this publication in one or more of the following steps, in according to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the version submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf


Received: 04/25/2020

Revised: 05/05/2020







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