Comparison of different eye care methods to prevent dry eye and corneal ulcer in older critically ill patients: A three-arm randomised clinical trial.

Background: As the population ages, the number of older patient admitted to intensive care units (ICUs) will increase. This age group is at higher risk for developing eye problems because of higher prevalence of dry eye among older people. Inconsistency of early studies' results and less attention to eye care guidelines for older patients in the ICU pose severe consequences such as dry eye and corneal ulcer.

Objective: The objective of this study was to investigate the effectiveness of artificial tear gel, polyethylene cover, and conventional eye care methods for preventing dry eye and corneal ulcer in older patients admitted to an ICU.

Methods: In this three-arm randomised clinical trial, 99 older ICU patients with Glasgow Coma Scale scores measuring <7 were randomly assigned to one of three treatment groups: (i) participants who received artificial tear gel in one eye and polyethylene cover on the other; (ii) these interventions were applied in the opposite eyes; and (iii) participants who received conventional eye care including antiallergic adhesive to closed eyelids. Development of dry eye and corneal ulcer was assessed based on Schirmer's and the fluorescein tests for 5 days. Repeated measures analysis of variance was used to detect differences between groups.

Results: The mean age of the participants was 70.91 (±9.47). No statistically significant difference was observed between the groups regarding baseline demographic and disease characteristics. While there was a nonsignificant difference between artificial tear gel and polyethylene cover in reducing dry eye and corneal ulcer, each of these methods could reduce dry eye and corneal ulcer significantly (P < 0.001) compared with conventional eye care.

Conclusions: The results revealed that artificial tear gel eye care and polyethylene cover methods were more effective in prevention of dry eye and corneal ulcer than antiallergic adhesive eye care. Nurses can choose an appropriate care method based on clinical conditions, costs, and care burden in older ICU patients.

Registration: Iranian Clinical Trial Registry (IRCT20200711048079N1). The first recruitment was conducted in October 2021.