Clinical indicators of dry eye severity nursing outcome in intensive care unit.

OBJECTIVE: to verify the extent of impairment of the clinical indicators of the nursing outcome Dry Eye Severity in patients admitted to the Intensive Care Unit. METHOD: cross-sectional, descriptive study developed with 206 patients. Based on the result listed, six indicators of the Classification of Nursing Results were evaluated with a questionnaire containing clinical variables and the Likert scale of the Classification of Nursing Results with constructed definitions, which varies from more impaired to non-impaired. The data were analyzed using descriptive and inferential statistics. RESULTS: the decrease in lacrimal production and the presence of redness in the conjunctiva were more impaired. The other indicators were more frequent for the absence of impairment: incomplete eyelid closure 81% (167), excessive tearing 95.1%(196), excessive mucous secretion 78.7% (162) and decreased blinking mechanism 50.5% (104). The clinical characteristics of hospitalization for neurological disorders, invasive mechanical ventilation, chemosis, use of sedatives, vasoconstrictors, benzodiazepines, antibiotics and corticosteroids interfered in the impairment of the dry eye severity. CONCLUSION: the result indicators show that the clinical characteristics of patients in the intensive care unit interfere in the impairment and in the dry eyes severity. According to these results, the importance of assistance directed to the prevention of eye diseases is emphasized.

Olho seco em pacientes críticos: revisão integrativa / El ojo seco en pacientes en estado crítico: revisión integradora / Dry eye in critically ill patients: integrative review

Objetivo: identificar na literatura publicações sobre os fatores de risco para o olho seco em pacientes internados em Unidade de Terapia Intensiva (UTI) de adultos. Método: Realizou-se busca nas bases de dados Medical Literature Analysis and Retrieval System Online (MedLine), Cumulative Index of Nursing and Allied Health (CINAHL), Web of Knowledge, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cochrane, Instituto Brasileiro de Engenharia de Custos (IBECS) e Banco de Dados em Enfermagem (BDENF). Foram identificadas 620 publicações potencialmente elegíveis, selecionando-se, ao final, 27 publicações que atenderam aos critérios de inclusão. Essas foram analisadas por dois pesquisadores independentes, usando-se instrumento adaptado para verificar o nível de evidência. Resultado: Foram identificados 39 diferentes fatores de risco para olho seco, sendo os apontados em 50% ou mais dos estudos, o lagoftalmo (85,18%), o uso de sedativos (70,37%), a ventilação mecânica (66,66%) e o uso de bloqueadores musculares (55,55%). Conclusão:Foi encontrado somente um estudo que abordasse especificamente o problema do olho seco em pacientes críticos; estudos clínicos são necessários, a fim de se apresentar evidências científicas fortes ao problema.

Objective: to identify in peer literature publications on the risk of dry eye in patients admitted to adult intensive care units. Methods: A study in the databases MedLine, CINAHL, Web of Knowledge, LILACS, Cochrane, IBECS and BDENF was conducted. In these, 620 potentially eligible studies were found, and from those, 27 met the inclusion criteria and were selected. The studies were analyzed by two independent researchers who used an instrument adapted to identify the level of evidence of the articles. Results: 39 different risk factors for dry eye were identified; the following risk factors were found in 50% ormore of the studies: lagophthalmos (85.18%), use of sedatives (70.37%), mechanical ventilation (66.66%) and the use of neuromuscular blocking agents (55.55%). Conclusion: It was found only one studythat specifically addressed the dry eye problem in critically ill patients, further clinical studies are necessary in order to provide strong scientific evidence on the subject.

Objetivo: identificar los trabajos publicados sobre los factores de riesgo para el ojo seco en pacientes ingresados en la unidad de cuidados intensivos para adultos. Método: Fue realizada una búsqueda en las bases de datos MedLine, CINAHL, Web of Knowledge, LILACS, Cochrane, IBECS y BDENF. Se identificaron 620 artículos potencialmente elegibles, mediante la selección final de 27 publicaciones que cumplieron los criterios de inclusión. Estos fueron analizados por dos investigadores independientes, utilizando un instrumento adaptado para comprobar el nivel de evidencia. Resultados: Se identificaron 39 factores de riesgo diferentes para el ojo seco; y señaló en 50% o más de los estudios: lagoftalmos (85.18%), sedantes (70.37%), ventilación mecánica (66,66%) y el uso de bloqueo neuromuscular (55,55%). Conclusión: Sólo un estudio que aborda específicamente el problema de ojo seco se encontró en los pacientes críticamente enfermos; se necesitan estudios clínicos con el fin de proporcionar una fuerte evidencia científica al problema.

Efeito de intervenções de enfermagem na prevenção de olho seco em pacientes críticos: ensaio clínico randomizado / Effect of nursing interventions on dry eye prevention in critically ill patients: Randomized Clinical Trial

Objetivo: Avaliar o efeito de intervenções de enfermagem (lágrima artificial em gel e lágrima artificial líquida) na prevenção de olho seco em pacientes internados em Unidade de Terapia Intensiva geral de adultos, de um hospital filantrópico no Brasil. Casuística e Métodos: Foram incluídos pacientes clínicos e cirúrgicos admitidos na Unidade de Terapia Intensiva geral de adultos de um hospital filantrópico, que atendessem aos seguintes critérios: ter mais de 18 anos; não apresentar olho seco no momento da admissão; estar em terapia de ventilação mecânica; piscar de olhos menor que 5 por minuto e avaliação na escala de coma de Glasgow menor ou igual a 7. A amostra final foi composta por 140 indivíduos que foram alocados aleatoriamente para os grupos do estudo, sendo 70 pacientes para o grupo lágrima artificial líquida e 70 pacientes para o grupo lágrima artificial gel. Os pacientes foram acompanhados por 5 dias consecutivos e avaliados diariamente através do exame ocular com o teste de fluoresceína, que avalia a presença de lesões corneanas, e pelo teste de Schirmer I, para se verificar a quantidade de lágrima produzida. A avaliação do efeito do cuidado ocular foi medido comparando cada grupo, bem como os dois grupos entre si, através do valor da incidência de olho seco (desfecho primário) encontrado em cada grupo. Os resultados foram apresentados por meio de frequência simples, medidas de tendência central (média) e medidas de variabilidade (desvio-padrão), a fim de caracterizar e descrever a população de pacientes. As comparações entre os grupos foram realizadas por teste exato de Fisher e pelo teste não paramétrico de Mann-Whitney. Foi calculada a taxa de incidência global do olho seco e o efeito das intervenções foi expresso por meio do risco relativo e intervalo de 95% de confiança, sendo este ajustado por fatores de risco (idade, sexo e exposição ocular), em um modelo de regressão de Poisson. Resultados: A incidência global de olho seco até ...

Objective: To evaluate the effect of nursing interventions (artificial tear on gel and liquid artificial tear) in the prevention of dry eye in patients hospitalized in an adult General Intensive Care Unit of a philanthropic hospital in Brazil. Casuistry and Methods: We included clinical and surgical patients admitted to the General Intensive Care Unit of adults of a philanthropic hospital, who met the following criteria: being over 18 years old; dry eye at admission; being in mechanical ventilation therapy; blink of less than 5 per minute and Glasgow coma scale score less than or equal to 7. The final sample consisted of 140 individuals randomly allocated to the study groups, of which 70 were patients for the liquid artificial tear group and 70 patients for the artificial tear gel group. The patients were followed for 5 consecutive days and evaluated daily through the ocular examination with the fluorescein test, which evaluates the presence of corneal lesions, and the Schirmer I test, in order to verify the amount of tear produced. The evaluation of the ocular care effect was measured by comparing each group as well as the two groups with each other, using the value of dry eye incidence (primary outcome) found in each group. The results were presented by means of simple frequency, measures of central tendency (average) and measures of variability (standard deviation), in order to characterize and describe the population of patients. Comparisons between groups were performed by Fisher's exact test and the non-parametric Mann-Whitney test. The overall incidence rate of dry eye was calculated and the effect of the interventions was expressed by relative risk and 95% confidence interval, adjusted for risk factors (age, sex and ocular exposure) in a model of regression. Results: The overall incidence of dry eye up to the 5th day of hospitalization was higher in the liquid artificial tear group, and among...

Computer Vision Syndrome: A Review of Literature.

Computer vision syndrome is caused by prolonged computer use. Symptoms, treatments, and recommendations are discussed.

Ocular toxicities of epidermal growth factor receptor inhibitors and their management.

Epidermal growth factor receptor (EGFR) inhibitors have become an important therapy for patients with malignant solid tumors, such as non-small cell lung, breast, ovarian, colorectal, renal, esophageal, sarcoma, mesothelioma, prostate, head and neck, and pancreatic cancers. Although these agents are generally well tolerated, some adverse effects will likely occur. The most common adverse effect associated with use of EGFR inhibitors is an acne-like rash. Less reported in the literature are adverse ocular reactions, which occur in approximately one third of patients and can cause significant discomfort. The ocular toxicities that may occur with use of EGFR inhibitors can be broadly categorized as changes in the eyelids (eg, squamous blepharitis, trichomegaly, meibomitis), changes in the tear film (eg, dysfunctional tear syndrome), and miscellaneous changes (eg, iridocyclitis, corneal epithelial defect). Early recognition and management of these adverse ocular reactions are necessary to improve patient comfort, to facilitate compliance, and to avoid interruption of therapy. This article describes the adverse ocular effects reported to occur with use of EGFR inhibitors and presents specific strategies to manage these effects. Mild eyelid and tear film changes usually can be managed by the oncology and nursing staff. More severe ocular reactions require involvement of an ophthalmologist.

Tratamiento con lagrimas artificiales hipotonicas en pacientes con ojo seco, clínica del oo, La Paz- Bolivia / Treatment of dry eyes with hypotonic artificial tears Clinica del Ojo La Paz-Bolivia

Objetivo. Evaluar el efecto del tratamiento con lagrimas artificiales hipotónicas en pacientes con ojo seco que residen a 3.600 m.s.n.m. Diseño. Ensayo clínico controlado a dobre ciego. Lugar. Clínia del Ojo. Centro de atención Primaria en salud ocular. La Paz-Bolivia. Participantes 90 pacientes fueron divididos end os grupos: experimental y control. Intervenciones. Grupo experimental utilizó lagrimas artificiales hipotónicas, 1 gota 4 qid en ambos ojos. Grupo control, utilizó lagrimas artificiales isotónicas 1 gota 4 qid en ambos ojos, por ellapso de 30 días. Previo consentimiento escrito. Duración total del estudio incluyendo recolección de datos y análisis 8 meses. Mediciones de los resultados principales. Mediciones de los resultados principales. Medición se realizo mediante protocolos pre y pos tratamiento y exámenes bajo lámpara de hendidura. Resultados. Ardor: 26 por ciento del grupo experimental y 20 por ciento del control tuvieron una evolución favorable p<0-05. Quemazon: 29 por ciento del grupo experimental y 13 por cineto del grupo control tuvieron una evolución favorable, p<0.05. Sensación de cuerpo extraño: 21 por ciento del grupo experimental y 19 por ciento del control tuvieron una evolución favorable p<0.05. Fatiga ocular: 20 por ciento del grupo experimental y 19 por ciento del control, tuvieron una evolución favorable p<0.05. Sequedad ocular: 32 por ciento del grupo experimental y 14 por ciento del control tuvieron una evolución favorable p<0.05. Bajo lámpara de hendidura. Grupo experimental: 49 por ciento tuvo mejorías significativas. Grupo control: 27 por ciento tuvo mejorías p<0.01 RRR: 98 pora ciento RRA: 97. NNT: 1.03 Intervalos de confianza de 95 por cieto de RRA y NNT IRA 24 por ciento IRR 18 por ciento NND 4.16. Conclusiones Se sugiere que las lagrimas artificailes hipotónicas son las ideales para el trataemitno del ojo seco en la altura.

The dry eye: an introduction.

Understanding the dry eye would be a great deal easier if we thoroughly understood normal tear function. To date, many aspects of tear function remain poorly understood. Only when normal tear characteristics and function are fully illuminated will the treatment of tear abnormalities and ocular surface disease be remedied. This instructional article aims to provide the reader with basic information regarding tear production, abnormalities, and current therapies in order to permit ophthalmic health care providers to intervene and teach patients who suffer from the frustrating and often chronic maladies associated with a dry eye.