Prolonged prone positioning of COVID-19 patients can lead to vision loss

Prolonged prone positioning of COVID-19 patients can lead to vision loss


Comprehensive Ophthalmology, Neuro-Ophthalmology/Orbit


The authors of this case series detail ocular abnormalities in 2 patients with COVID-19 after prolonged prone positioning.

Study design and outcomes

These findings detail the first-hand observation by one ophthalmologist at a tertiary New York medical center during April and May 2020. Critically ill patients with COVID-19 can benefit from prolonged prone positioning to improve oxygenation.

Outcomes

Four of 16 ICU patients required prolonged prone-position ventilation and developed significant periorbital edema. Two patients who had 9 and 4 sessions of 18-hour ventilation in the prone position developed orbital compartment syndrome (increased IOP of 2- to 3-fold in prone positioning) and papillophlebitis (optic disc elevation with associated hemorrhages). The other two patients had normal fundus examination, but had fewer sessions of pone positioning (1 and 3 sessions, respectively).

The ophthalmic findings seen in these critically ill COVID-19 patients may be related to the combined effects of increased orbital venous pressure during prolonged prone positioning and COVID-19—associated coagulopathy.

Limitations

These findings are the observations of a single ophthalmologist.

Clinical significance

This report suggests permanent vision loss is possible following prolonged prone positioning. Care should be taken to cushion the eyes to minimize pressure on the globe during prone positioning. If possible, maintaining head position above heart level can decrease dependent swelling.