It is unfortunately apparent that we are in the middle of an ongoing outbreak of the coronavirus disease that, according the World Health Organization, has now been characterized as a pandemic. It appeared to have started in December 2019 when the first cases of pneumonia of an unknown cause were detected in Wuhan (Hubei, China). This led to a rapid outbreak due to a novel strain of the coronavirus called SARS-CoV-2, which stands for severe acute respiratory syndrome coronavirus 2. The associated disease, now referred to as COVID-19, rapidly spread in mainland China and then in the rest of the world. According to the US Center for Disease Control and Prevention and the European Centre for Disease Prevention and Control, the virus is thought to spread mainly from person-to-person via respiratory droplets transmission. An infected person produces droplets containing viable virus and relays them by sneezing, coughing, or exhaling. The SARS-CoV-2 (as other coronaviruses) can survive for several hours on object surfaces. Although this is not considered the main way the virus spreads, it may be possible that a person can get the virus by touching a surface that has the virus on it and then touching their own mouth, nose or eyes. Of particular concern for ophthalmic practitioners, it should be noted that SARS-CoV-2 has been detected in the tears and conjunctival secretions in COVID-19 patients with conjunctivitis. Contact lens (CL) practice can be particularly exposed to these modalities of transmission.

CL practice involves face-to-face communication, close examination of the patient and need to directly touch a patient's eyelids. Some CLs are still fitted using trial sets, which will need to be cleaned thoroughly between patients. In terms of patient management, efforts should be made to lower patient attendance to CL practices. Each patient should be contacted by phone or email for rescheduling of non-urgent appointments. In the case of a patient attending an appointment, it is important to evaluate the risk that the patient may pose, such as patients who travelled to outbreak areas within 14 days, and patients with cough or conjunctivitis. If patients are deemed to have increased risk factors, postpone appointments for at least 14 days, which is the current understanding of the incubation period of COVID-19. If someone presents with suspected COVID-19 then they should be isolated, and local health services must be informed. Exam rooms, waiting areas and optical areas should be thoroughly cleaned as well as assuring safe distance between patients in the waiting rooms. Personal protective equipment such as eye protection, water-resistant gloves with long tight-fitting cuffs and surgical-style face masks should be adopted. Installation of protective shields on slit lamps and disinfection of CL equipment and CL trial sets is advised. Hand sanitization must be performed via hand washing before and after significant contact with any patient even when gloves are worn. Hand sanitization includes cleansing hands with an alcohol-based hand rub, soap and water, or both. Practitioners must avoid touching their own face, nose, mouth and eyes. Patients should be reminded to clean their CLs correctly, disinfecting fully between usage and not using disposable CLs longer than they are intended. Patients should seek advice if sick and discontinue CL use if they have any malaise.

This outbreak is evolving rapidly, the impact to the public health risks to be massive, with huge economic and social disruption. In the time of coronavirus, CL practice will become more difficult. As CL practitioners, we have the responsibility to minimize the transmission of COVID-19 in CL practice based on current scientific evidence.

The Coronavirus Disease 2019 (COVID‐19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is not only spreading throughout China but has reached more than 20 countries, and has already posed threats to global health and economy. So far, the number of people infected in China has climbed to more than 70,000. Of them, at least 3,019 healthcare workers have been infected. However, the specific causes of infection among healthcare workers in hospital environments are unclear. It has been confirmed that COVID‐19 is mainly transmitted through both respiratory droplets and direct contact. Aerosols are another possible transmission route requiring attention. In February 2020, a report in The Lancet raised the issue that ocular surfaces may be a potential target for SARS‐CoV‐2 invasion. However, two recent studies do not fully support this assumption. The reason is that although a small number of COVID‐19 patients have conjunctivitis, not all of them show positive test of SARS‐CoV‐2 nucleic acid in conjunctival sac swabs. In addition, some patients did not have conjunctivitis despite positive test results for the SARS‐CoV‐2 nucleic acid in their conjunctiva sac swabs. Interestingly, the medical history of the clinical physicians with COVID‐19 revealed that neither of them used eye goggles when examining (physician 1) and intubating infected patients (a high‐risk procedure to produce aerosol) (physician 2).

Studies show that, like the severe acute respiratory syndrome coronavirus (SARS‐CoV) that caused SARS, SARS‐CoV‐2 binds to human angiotensin‐enzyme II (ACE2), using it as a cell entry receptor to invade respiratory and lung epithelium through the spike (S) protein. However, ACE2 is mainly expressed in posterior tissues of the eye, such as the retina and the retinal pigment epithelium, not in the human conjunctival and corneal epithelium. We presume that these previous studies ignored the characteristics of lacrimal drainage. Tears are constantly renewed by the lacrimal system. Therefore, we speculate that the virus enters the tears through droplets, which may pass through the nasolacrimal ducts and then into the respiratory tract. Combined with all this information, we assert that, when coming into contact with confirmed or suspected cases of COVID‐19, healthcare workers should wear eye safety goggles. This should become one of the critical measures for preventing the spread of COVID‐19. The authors hope this topic is helpful for work in the outbreak area.