Effectiveness of Nursing Interventions to Prevent Dry Eye in Critically Ill Patients

Diego Dias de Araujo, PhD, MSN, RN; Daniel Vinicius Alves Silva; Carolina Amaral Oliveira Rodrigues; Patricia Oliveira Silva; Tamara Goncalves Rezende Macieira, BSN; Tania Couto Machado Chianca, PhD, MSN, RN


Am J Crit Care. 2019;28(4):299-306. 

In This Article

Abstract and Introduction


Background: Critically ill patients are susceptible to the development of dry eye. Few studies have been conducted on how to best prevent and treat this condition.

Objective: To compare the effectiveness of 2 nursing interventions in preventing dry eye in adult intensive care unit patients: liquid artificial tears (Lacribell; Latinofarma) and artificial tears gel (Vidisic Gel; Bausch and Lomb).

Methods: In this randomized controlled trial, 140 participants were randomly assigned to 1 of 2 treatment groups: a liquid artificial tears group (n = 70) and an artificial tears gel group (n = 70). The study inclusion criteria were as follows: admission to the intensive care unit, age of 18 years or older, no diagnosis of dry eye at admission, receipt of mechanical ventilation, blink rate of less than 5 times per minute, and a score of 7 or less on the Glasgow Coma Scale. On 5 consecutive days, a single researcher who was unaware of the treatment assignment assessed the participants' eyes using the fluorescein eye stain test and the Schirmer test for dry eye.

Results: Dry eye developed in 21% of participants who received liquid artificial tears versus 9% of participants who received artificial tears gel (P = .04).

Conclusions: In this study, artificial tears gel was superior to liquid artificial tears in preventing the development of dry eye. These results may help nurses deliver evidence-based eye care aimed at reducing the risk of dry eye in critically ill patients.


Intensive care unit (ICU) patients often have conditions leading to compromised physiological mechanisms of eye protection. These conditions include being unconscious or comatose; taking several medications such as diuretics, sedatives, and β-blockers; receiving mechanical ventilation; and being exposed to air conditioning and low air humidity.[1–4] Consequently, these patients are susceptible to the development of dry eye and other ocular surface disorders.[4–7]

Clinical guidelines that have been developed for eye care in the ICU refer to a variety of interventions designed to reduce the prevalence and incidence of ocular surface alterations in critically ill patients, such as corneal ulcerations and keratitis. These interventions include ointments, liquid eyewashes, gels, moist gauze, paraffin gauze, hydrogel, and polyethylene film.[6–8]

Dry eye has been defined as a multifactorial change in tears and the ocular surface that results in discomfort, visual disturbances, and tear film instability, with potential damage of the ocular surface.9 In nursing, the diagnosis of "risk for dry eye" is applied to patients who are "vulnerable to eye discomfort or damage to the cornea and conjunctiva due to reduced quantity or quality of tears to moisten the eye, which may compromise health."[10] (p387)

"Fifty-three percent of adult patients admitted to intensive care units have dry eye."

A recent study in Brazil showed that dry eye is a common problem in patients admitted to ICUs, with an incidence of 53%.[5] Intensive care unit patients have a higher probability of dry eye developing than do other hospitalized patients because of a variety of internal and external risk factors.[1–3,5] Dry eye can be chronic and progressive, imposing limitations on patients' ability to perform activities of daily living and negatively affecting their quality of life. Therefore, a preventive approach that includes appropriate eye care is crucial to minimize the risk of dry eye and avert possible complications.

Because nurses are the frontline health care providers in hospitals, they have an important role to play in reducing the risk of dry eye in critically ill patients through effective nursing interventions. A study reported in 2011 compared the effectiveness of 2 nursing interventions—polyethylene film and carbomer drops—in the prevention of dry eye among 18 adult ICU patients.[2] The polyethylene film was found to prevent dry eye in all of the cases, while the carbomer drops were effective in only 17% of the patients (P < .001).[2] However, large studies of polyethylene film for the prevention of dry eye have not yet been conducted. Moreover, more research is needed on evidence-based nursing interventions that result in less discomfort for patients and can be more easily applied by nurses than polyethylene film. Therefore, this study was conducted to compare the effectiveness of 2 nursing interventions in preventing dry eye in adult patients admitted to an ICU: liquid artificial tears (Lacribell; Latinofarma) and artificial tears gel (Vidisic Gel; Bausch and Lomb).