Ocular Complications in the Prone Position in the Critical Care Setting: The COVID-19 Pandemic

J Intensive Care Med. 2021 Mar;36(3):361-372. doi: 10.1177/0885066620959031. Epub 2020 Sep 28.


Purpose: Ocular complications are common in the critical care setting but are frequently missed due to the focus on life-saving organ support. The SARS-CoV-2 (COVID-19) pandemic has led to a surge in critical care capacity and prone positioning practices which may increase the risk of ocular complications. This article aims to review all ocular complications associated with prone positioning, with a focus on challenges posed by COVID-19.

Materials and methods: A literature review using keywords of "intensive care", "critical care", "eye care", "ocular disorders", "ophthalmic complications," "coronavirus", "COVID-19," "prone" and "proning" was performed using the electronic databases of PUBMED, EMBASE and CINAHL.

Results: The effects of prone positioning on improving respiratory outcomes in critically unwell patients are well established; however, there is a lack of literature regarding the effects of prone positioning on ocular complications in the critical care setting. Sight-threatening ophthalmic disorders potentiated by proning include ocular surface disease, acute angle closure, ischemic optic neuropathy, orbital compartment syndrome and vascular occlusions.

Conclusions: COVID-19 patients may be more susceptible to ocular complications with increased proning practices and increasing demand on critical care staff. This review outlines these ocular complications with a focus on preventative and treatment measures to avoid devastating visual outcomes for the patient.

Keywords: COVID-19; critical care; eye care; eye disorders; ocular complications; prone positioning.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Administration, Ophthalmic
  • COVID-19 / therapy*
  • Compartment Syndromes / etiology
  • Conjunctival Diseases / etiology
  • Critical Care
  • Eye Diseases / etiology*
  • Glaucoma, Angle-Closure / etiology
  • Humans
  • Intensive Care Units
  • Keratitis / etiology
  • Keratitis / prevention & control
  • Ointments / therapeutic use
  • Optic Neuropathy, Ischemic / etiology
  • Orbital Diseases / etiology
  • Patient Positioning / adverse effects*
  • Prone Position*
  • Retinal Artery Occlusion / etiology
  • SARS-CoV-2


  • Ointments