Since its emergence from Wuhan, China, at the end of 2019, COVID-19 has spread to every continent except Antarctica and has claimed the lives of tens of thousands of people, affecting nearly a million as of this writing. And these numbers are only projected to get worse. They’ve left essential businesses wondering what infection control measures to put in place, and eyecare providers may have an answer.

There is a large possibility that this pandemic may involve ocular transmission. Singapore was one of the first countries the virus reached, prompting its National University Hospital Department of Ophthalmology to offer recommendations to limit exposure in clinics worldwide that still need to provide care. 

Evaluate Urgency

For patients requesting follow-ups, the hospital evaluates them based on three criteria: presence of infective signs or symptoms, visitation to China within the last 14 days and close contact with anyone who was diagnosed with COVID-19. Appointments proceed normally for those who do not meet any of the criteria. Emergent patients who fulfill at least one criterion receive a consult in an isolation room by eyecare providers who have taken the necessary protective measures. Non-urgent follow-ups are postponed.

Taking proper precautions while seeing patients on a case-by-case basis ensures the continued safety and health of both patients and healthcare workers. Workers need to be especially aware of the protective equipment they use, as overuse could lead to shortages later on and underuse could increase the risk of infection. 

Gear Up

The National University Hospital Department of Ophthalmology requires its workers to wear an N95 mask, gown, face shield and gloves when interacting with patients who fulfill at least two criteria. For patients who only fulfill one, workers wear a gown, a surgical mask, a face shield and gloves. In the event that one of these patients is febrile, workers escalate to an N95 mask. All patients sit behind a protective shield of radiography films to reduce droplet transmission from coughs and sneezes. To ensure these protocols are working, healthcare workers must report their temperatures twice daily and any infective signs or symptoms that arise.

To further limit exposure, proper disinfection must occur. Any equipment coming into contact with ocular tissue should be disinfected with 70% ethyl alcohol, intraocular pressure monitoring devices can be sterilized with 10% diluted sodium hypochlorite and isolation rooms must be sterilized after each use.

From an eyecare center that has been affected by COVID-19 to one that will likely feel its impact in the near future, these protective measures are worth taking into account to safely provide continued patient care without compromising health.

Jun ISY, Hui KKO, Songbo PZ. Perspectives on coronavirus disease 2019 control measures for ophthalmology clinics based on a Singapore center experience. JAMA Ophthalmol. March 31, 2020. [Epub ahead of print].