From the Guidelines
No, patients requiring q1 hour eye drops do not necessarily need ICU admission, as the decision should be based on the patient's overall clinical condition, not solely on medication frequency. When considering the management of patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), the guidelines recommend hourly application of topical treatments in certain situations, such as suspected corneal infection, which may require hourly use of broad-spectrum topical antibiotic therapy 1. However, this does not necessarily imply the need for ICU admission. Key factors to consider include:
- The patient's overall stability
- The reason for the frequent eye drops
- The hospital's staffing capabilities
- The potential for complications, such as corneal exposure, ulceration, or infection, which may require more intensive monitoring 1 In general, most patients requiring hourly eye drops can be managed on regular medical floors with appropriate nursing support, as long as the nursing staff is informed about the importance of adhering to the hourly schedule. In some cases, arrangements can be made for more frequent nursing checks or patient self-administration with supervision. The goal is to provide appropriate care in the least restrictive environment while ensuring medication adherence and minimizing the risk of complications, such as those associated with corneal exposure or infection 1.
From the Research
Patient Admission to ICU for Hourly Eye Drops
- The need for hourly eye drops does not necessarily require admission to the Intensive Care Unit (ICU) 2, 3.
- However, certain conditions such as acute angle closure glaucoma may require close monitoring and treatment in an ICU setting, especially if the patient is already critically ill or requires invasive mechanical ventilation 2.
- The use of certain medications, such as sympathomimetics and beta agonists, can increase the risk of developing acute angle closure glaucoma, and sedated patients may be at risk of delayed diagnosis 2.
- In some cases, patients may require ICU admission due to systemic side effects of ophthalmic medications, such as Timolol Maleate, especially if they have other comorbidities or are taking other cardiodepressant drugs 3.
Predicting Admission to ICU
- Paramedics have limited ability to predict whether patients require admission to the hospital or the level of care needed, including ICU admission 4.
- Predicting admission to ICU based solely on paramedic determination may not be reliable, and prehospital diversion policies should consider other factors 4.
Eye Care in ICU Patients
- Eye dryness and corneal abrasion are common problems in ICU patients, especially those who are comatose or sedated 5.
- The use of eye lubricants is more effective than closing eyes with adhesive tape in preventing corneal abrasion 5.
- Regular eye assessment and care should be an essential part of nursing care for patients in ICU to prevent eye complications 5.