Ocular Complications During Prone Positioning Ventilation in Critically Ill Adults: A Systematic Review

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ABSTRACT Aim To synthesise ocular outcomes, assessment methods and associated factors among critically ill adults exposed to prone positioning ventilation. Design Systematic review with narrative synthesis. Review Methods Two reviewers independently completed study selection, data extraction and methodological appraisal. Findings were synthesised narratively because heterogeneity precluded meta‐analysis. Data Sources PubMed, Embase, CINAHL, Web of Science and the Cochrane Library were searched from inception to November 2025, with backward citation searching. Results Seven studies involving 722 critically ill adults were included. Reported findings included chemosis, exposure keratopathy, conjunctival abnormalities and increased intraocular pressure. Chemosis and exposure keratopathy were the most frequent ocular surface manifestations. Two studies evaluated physiological increases in intraocular pressure rather than clinical complications, and several mixed intensive care cohorts lacked prone‐position‐specific estimates. Reported associated factors included lagophthalmos, deeper sedation, higher positive end‐expiratory pressure, prolonged or repeated prone positioning and increased ocular secretions, although multivariable evidence was limited. Conclusion Critically ill adults exposed to prone positioning may develop ocular abnormalities, but heterogeneous designs, assessment methods, and outcome reporting prevent reliable estimation of incidence. Implications for the Profession and/or Patient Care Ocular risk assessment should be integrated before, during, and after prone positioning. Preventive eye care, repeated assessment, documentation, and timely ophthalmological referral may support early identification and reduce avoidable injury. Impact This review addresses fragmented evidence on ocular safety during prone positioning, identifies common ocular findings and highlights clinically relevant associated factors. The findings are relevant to critical care nurses and prone‐positioned adults. Reporting Method The review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses 2020 statement. No Patient or Public Contribution Patients and the public were not involved because this review analysed published studies. Trial and Protocol Registration International Prospective Register of Systematic Reviews, CRD420251268507.