Ocular Complications Of Covid-19 Patients In Intensive Care Units: From Exposure Keratopathy To Ocular Rupture

Since its first description in December 2019, coronavirus disease 2019 (COVID-19) has progressed to a pandemic and a global health emergency. Patients with COVID-19 can develop acute respiratory distress syndrome, requiring mechanical ventilation and critical care treatment, which leads to an unparalleled rise in intensive care admissions. Depressed mental status, multiorgan failure, both non-invasive and mechanical ventilation, and prone position are critical risk factors for the development of ocular complications. The purpose of this work is to describe ocular complications observed in patients with COVID-19 admitted to intensive care units in our tertiary centre.

Centro Hospitalar Universitário de São João, in Porto, Portugal.

A retrospective study was performed, based on the survey review of electronic medical records of all hospitalized patients in our centre with requests for internal consultation by an ophthalmologist from January 2020 to December 2021. From 342 requests, only 9 were related to COVID-19 patients hospitalized in intensive care units and were selected. Mean age was 62 ± 14 years old and 6 (66%) were male patients. All patients were under mechanical ventilation or extracorporeal membrane oxygenation.

In all cases, the request for ophthalmological evaluation was motivated by unilateral or bilateral red eye. 5 cases of exposure keratopathy (3 with only epithelial defects and 2 with concomitant stromal affection), 1 bacterial conjunctivitis, 1 subconjunctival haemorrhage, 1 bacterial corneal ulcer and 1 ocular rupture were identified. Exposure keratopathy occurred in sedated patients with lagophthalmos and no blinking reflex and hospitalized for 25 ± 11 days. Rupture occurred in an eye with scleral thinning due to previous extracapsular cataract extraction. There was no record of major eye trauma, but the patient was requiring mechanical ventilation in prone position due to severe hypoxemic respiratory failure.

In the setting of intensive care, the primary aim of any physician is to keep the patient alive. However, ocular morbidities can be severe and permanently affect quality of life. From the 9 patients of our sample, 4 survived, including the patient with a bacterial corneal ulcer, which developed a paracentral leukoma, and the one with an ocular rupture, which was submitted to surgery after systemic stability but nonetheless became blind from this eye. We highlight the need for strong cooperation between ophthalmologists and intensivists to promote regular eye evaluations in ICU admitted patients and to adopt preventive measures to minimize irreversible sight-threatening ocular complications.