Year: 2026
Type: article
Abstract: I used to think my role in seeing ICU patients was straightforward: check the eyes, write my note, and move out of the way of those keeping the patient alive.On a particular Tuesday night, I saw how even a "simple" ophthalmology consult can be part of how we care for patients at the end of life.I was the ophthalmology resident on call when my phone vibrated with a new consult request.It came from the MICU: "cloudy eye, " ventilated patient, rule out ulcer.She was seventy-two, according to the chart.Stage IV lung cancer.ARDS.Septic shock.Pressors, dialysis, tube feeds, a list of drips that amounted to everything, all at once, all the time.Her name was Mrs. L. I confirmed it from the bracelet on her wrist, not from her lips, which were parted only enough for the endotracheal tube.The ventilator sighed and pushed and sighed again."Her right eye looks hazy now, " the nurse said, keeping her voice low, as if the patient might be sleeping instead of sedated and paralyzed."Family was worried.Attending wanted ophtho to take a look."We are very good at taking a look.I barely needed to open her eye.The lid came up halfway on its own: lagophthalmos, exposure.The cornea was dull and stippled, the once-clear surface now with a faint grayness.I turned on my penlight and watched the beam sweep across the eye.There it was: an irregular opacity near the bottom, right where the cornea had been drying out.Early ulcer.One more complication in a body already crowded with them.I did what I had been trained to do.Fluorescein strip.Cobalt blue light.A vague crescent of uptake.No hypopyon.Pupil sluggish but symmetric.I documented my findings in the workstation next to the bed.Assessment and plan: exposure keratopathy with early ulceration in the setting of prolonged intubation and incomplete lid closure.Recommend lubricating ointment every 2 hours, moisture chamber, gentle taping of the lids between checks, consider temporary tarsorrhaphy if prognosis allows. If prognosis allows.Her daughter had slipped into the room, wrapped in a cardigan too thin for the airconditioned chill.She watched me with the particular intensity of someone who hasn't understood most of what has happened for days but has learned to track who is new."You're the eye doctor?" she asked."Yes." "Is she…going blind now too?"I thought about all the things I had read in her chart.Fluid overload.Kidney failure.Congestion hepatitis.Respiratory failure.Encephalopathy.I had read the phrase "this is likely a terminal hospitalization" in a recent attending physician note.There was part of me that wanted to blurt out this ulcer is the least of her problems."Her eye is dry and a little infected, " I managed."That's usually uncomfortable.We can't ask her, but I'm going to start some treatments to protect the surface of the eye, so if she wakes up, she's more likely to see comfortably."Her daughter nodded slowly."She loves to read, " she said."Or she used to.She always said if she lost her eyesight, that would be the end." I looked at the tangled wires and lines hooked up to her body, thought of the "Full code" status in the chart.I wondered what "the end" meant here, and for whom.The palliative care team often talks about goals of care, values, priorities.They schedule family meetings, gather chairs, turn their phones to silent for a set block of time.They say "big picture" and "where we go from here."Ophthalmology is rarely in those meetings.We stop by instead when everyone else is gone, with fluorescein strips and ointment, asked to protect a clear cornea while so much behind the eye -and everywhere else -is falling apart.Later, at a nursing station nearby, I finalized my note.The cursor blinked after if prognosis allows.I left the phrase, even though I had a sense of the prognosis.The nurses knew.The family
Source: Palliative & Supportive Care
Author: Henry Bair
Institution: Wills Eye Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,550
Funder: University of Cambridge
OpenAlex ID: W7119096724
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