Ocular Injury Associated With Prone Positioning in Adult Critical Care: A Systematic Review and Meta-Analysis

Timothy J. Patterson*, Peter Currie, Michael Williams, Claire Shevlin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review



Prone positioning during the COVID-19 pandemic has become increasingly used as an adjunct to increase oxygenation in critical care patients. It is associated with an adverse event profile. This study sought to investigate the occurrence of ocular injuries reported in prone versus supine groups in adult critical care.


Systematic review and meta-analysis. 


A systematic review and meta-analysis were carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, SCOPUS, and the Cochrane Library were searched. The search period was January 1, 1990, to July 1, 2020. 


Eleven randomized controlled trials were included, with 2,247 patients. Twenty-eight events were recorded in 3 trials (174 patients) and no events in the other 8 trials (2,073 patients). The rates of eye injury were 5 events in 1,158 patients (1.30%) and 13 events in 1,089 patients (1.19%) in the prone and supine groups, respectively, which were reduced to 2 of 1,158 patients (0.17%) and 2 of 1,089 patients (0.18%), respectively, when reports of eye or eyelid edema were removed. Meta-analysis demonstrated no significant differences between groups with (an OR of 1.40 (95% CI: 0.37–5.27) and without (OR: 0.78; 95% CI: 0.11–5.73) reported edema. 


This meta-analysis showed no significant difference in the rate of reported ocular injury between prone and supine critical care groups. These rates remain higher than the incidence reported during general anesthesia. There is a need for studies in critical care settings in which ocular injury is an end-point and which include extended patient follow-up.

Original languageEnglish
Pages (from-to)66-73
Number of pages8
JournalAmerican Journal of Ophthalmology
Early online date03 Mar 2021
Publication statusPublished - Jul 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.

Copyright 2021 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Ophthalmology


Dive into the research topics of 'Ocular Injury Associated With Prone Positioning in Adult Critical Care: A Systematic Review and Meta-Analysis'. Together they form a unique fingerprint.

Cite this