Ocular disorders in non-invasive ventilation and CPAP therapy

Abstract

BACKGROUND: The benefits of non-invasive ventilation (NIV) in the treatment of several chronic and acute disorders are well documented. However, the side effects associated with this type of treatment must always be taken into account. Patients often fail to mention ocular symptoms. CLINICAL CASE: A male, 80 years old, autonomous in activities of daily living, with a personal history of chronic obstructive pulmonary disease (COPD) and chronic hypercapnic respiratory failure was admitted to the emergency room due to dyspnea and a depressed level of consciousness. The patient deteriorated to severe respiratory acidosis and was started on NIV. On the third day of admission there was note of significant ocular irritation in addition to a dermal lesion on the bridge of the nose. Ophthalmology reported a corneal ulcer and bilateral conjunctivitis and prescribed topical antibiotic and steroids, with improvement of the symptoms. DISCUSSION: Ocular disorders in relation with NIV are more common than documented in clinical practice. It's essential that every professional that deals with this type of therapy is sensitive to the recognition and early diagnosis of this secondary effect, motivating timely evaluation. This case exemplifies the rapid onset of this type of complication, especially if the staff is poorly trained in NIV application and in patients with a decreased level of consciousness. Centers need to develop protocols to evaluate patients under NIV for ocular symptoms, with the goal of early therapeutic intervention. The creation and divulgation of these procedures will drastically improve the quality of care to acute and chronic patients in need of NIV.