Ocular Alterations in Severe COVID-19 Patients with Invasive Mechanical Ventilation and Prolonged Pronation

This work was designed to investigate ocular alterations in patients affected by severe COVID-19 who required invasive mechanical ventilation and prolonged pronation to optimize lung ventilation areas.

Conjunctivitis seems to be the initial or only symptom of this pathology, other alterations in the ocular surface are chemosis, epiphora and ocular secretions. In the COVID-19 pandemic, the use of intensive care units, prolonged pronation, and invasive mechanical ventilation in the management of complicated patients increased greatly. The study design was descriptive, prospective, and cross-sectional, it was carried out in the Intensive Care Unit of the Specialties Hospital of the XXI Century National Medical Center, Mexican Institute of Social Security during the months of March and May 2021. All patients over 18 years of age, of both sexes with a positive test polymerase chain reaction (PCR) for COVID-19, who had the diagnosis of severe pneumonia associated with SARS-CoV-2 who were under invasive mechanical ventilation and who had more than 16 hours of pronation.

The mean age of the patients was 60 years. 68.9% had comorbidities. The most frequent findings in adnexa were blepharoedema and chemosis. In the ocular fundus, several alterations including cotton-wool lesions, intraretinal hemorrhages and arteriolar vasoconstriction were observed. The effect of the hours of pronation on the frequency of retinal alterations was statistically significant the group of patients without changes against those who had more than two retinal alterations. Having more than 145 hours of pronation increases the risk of having more than two retinal alterations. Intraocular pressure increased in pronation by 61 % with P < 0.05. In COVID-19 pneumonia that causes a critical state, it has been seen that there is a proinflammatory and thrombotic state and tissue ischemia due to decreased oxygen distribution, which is related to the development of multi-organ failure and this in turn.

The ocular alterations in patients with COVID-19 under invasive mechanical ventilation and prolonged pronation range from the ocular adnexa to the alterations in the fundus of the eye.

The relevance of this study lies in the fact that the patients were examined during the most severe period of the disease, where more systemic ischemic alterations could have manifested. These results suggest the need to implement a protocol for the primary and secondary prevention of ocular complications in patients with COVID-19, but which may be useful for patients who must remain in prolonged pronation for other medical indications.