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Dry Eye in Critical Care: Evidence-Based Practice

Purpose of the Study

A common problem for ICU patients is dry eye due to their conditions, such as being comatose or medications (diuretics, sedatives) that block physical mechanisms of maintaining moisture in the eyes. The dry eye conditions pose significant risks to damaging the ocular surface resulting in irritation or even loss of eyesight. Nurses have the role as frontline health workers to prevent this. The study attempts to establish which nursing intervention in the ICU is more effective and less discomforting, with the choice between the two: liquid artificial tears (Lacribell) or artificial tears gel (Vidisic Gel).

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Research & Design

A randomized controlled trial with a double-blind concept is effective for the purpose of this study of determining a non-biased objective approach to treating a clinical issue. The results in this design are more easily compared since they do not have to account for biases.


140 participants were used in the study, equally divided between the two groups. The inclusion criteria were patients aged 18 and older admitted to the ICU with no diagnosis of a dry eye upon admission, no mechanical ventilation, a blink rate of fewer than five times per minute as well as a score of 7 or less on the Glasgow Coma Scale.

Data Collection

Data collection was performed over five consecutive days where a researcher would perform ocular assessments of patients. Prior to the researcher’s observation, an assistant would clean up any traces of the intervention substance to maintain the blind approach. The ocular assessment included the Schirmer test and the fluorescein eye stain test.

Data Analysis

Data was entered into the Epi Info software program by two researchers independently. It was then analyzed by the R-3-2-3 software. Standard statistic tests were used, such as frequency, average, and standard deviation. The categorical variables were then compared with a Fisher exact test, while continuous variables were compared with Mann-Whitney Test. The Shapiro-Wilk test was also performed to test the normalcy of the distribution of variables.


One limitation noted by the researchers that were found to be highly interesting is the fact that the protocols for application of the interventions and ocular assessment were meant for the study and may not apply in clinical practice. This poses the question of whether the solutions tested are something that can be used in clinical patients in the ICU or further testing and clinical recommendations are needed.


The findings indicate that the most effective treatment was the artificial tears gel since only 9% of participants developed dry eye in that group. The other group with liquid artificial tears saw 21% of participants develop dry eyes, which was significantly higher. The interesting detail found from this study was the issue of dry eye in patients themselves. This could potentially apply to not only ICU patients but those in other departments with conditions or characteristics that may disrupt the nature moisturization of the eye. It is an important concept to consider for the safety and comfort of patients.

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Reading Research Literature

By reading research literature, nurses learn how to collect and interpret data, compare studies, critique results, and overall think critically. Information literacy inspires independent research and competent, evidence-based practice. Nurses must maintain up-to-date information on the latest medical research in their specialties to be more professional and easily accept change. An activity like this helps to break down the study and analyze independent elements that are important in critiquing and applying the research.


De Araujo, D. D., Silva, D. V. A., Rodrigues, C. A. O., Silva, P. O., Macieira, T. G. R., & Chianca, T. C. M. (2019). Effectiveness of nursing interventions to prevent dry eye in critically ill patients. American Journal of Critical Care, 28(4), 299-306. Web.

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