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Year : 2020  |  Volume : 32  |  Issue : 1  |  Page : 6-7

COVID-19 – Perspectives from an ophthalmologist's point of view

1 Department of Ophthalmology, Government Medical College, Thrissur, Kerala, India
2 Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India

Date of Submission14-Mar-2020
Date of Acceptance15-Mar-2020
Date of Web Publication17-Apr-2020

Correspondence Address:
Dr. V Sudha
Department of Ophthalmology, Government Medical College, Thrissur, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_32_20

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How to cite this article:
Sudha V, Ajithkumar K. COVID-19 – Perspectives from an ophthalmologist's point of view. Kerala J Ophthalmol 2020;32:6-7

How to cite this URL:
Sudha V, Ajithkumar K. COVID-19 – Perspectives from an ophthalmologist's point of view. Kerala J Ophthalmol [serial online] 2020 [cited 2020 Aug 8];32:6-7. Available from: http://www.kjophthal.com/text.asp?2020/32/1/6/282656

As we know the coronavirus disease-19 (COVID-19) viral infection has been officially declared a pandemic by the World Health Organization,[1] it was a Chinese ophthalmologist, Li Wenliang, who first raised concerns about this disease and who unfortunately subsequently succumbed in the fight against this scourge. The experience in China and Italy proves that it has a potential to do severe damage leading to deaths in large numbers. We, in Kerala, have been able to contain the disease to small numbers at the time of writing, thanks to the strong public health machinery and leadership.

The guidelines to prevent the spread of disease and manage suspected cases are evolving as the epidemic unfolds. It is our responsibility to update ourselves regarding the latest guidelines and follow it in our practice too.

What can we do to supplement the activities done by our colleagues?

  1. Let us make washing hand regularly/sanitizing hands a routine before and after examining every patient. Frequently wash our hands with soap and water for at least 20 s or use an alcohol-based hand rub with at least 60% alcohol. Always wash hands that are visibly soiled. Avoid touching our eyes, nose, or mouth with unwashed hands
  2. Ask every patient near us about respiratory symptoms. Have signboards near the front door asking patients to let us know if they are experiencing any of the symptoms of COVID-19
  3. If they have any, find out if they had a travel history/contact with anyone who travelled to a COVID-infected area
  4. Patients with any such history should be referred to appropriate authorities or triage area with due notification
  5. Patients who need our attention for conjunctivitis/any ophthalmic emergency, in the ophthalmic outpatient (OP), and having fever, cough, and shortness of breath should be taken to a specially designated and isolated clinic (a single-person room with the door closed) and seen by staff with full personal protective equipment (PPE). Personal eyeglasses and contact lenses are not considered adequate eye protection. Restrict the number of personnel entering isolation areas. Prevent crowding in the outpatient area
  6. Let us remember that we are a profession who are bound to work very close to the patient and we should be able to select and use appropriate mask/PPE/universal precautions depending on the risk stratification and guidelines. Use of slit-lamp breath shields; careful cleaning of equipment between patients; asking those patients who cough, sneeze, or have flu-like symptoms to wear masks during examination; and keep the talking to a minimum during the slit-lamp examination should be incorporated. These barriers do not, however, prevent the contamination of equipment and surfaces on the patient's side of the barrier, which may then be touched by staff and other patients and lead to transmission
  7. Let us make sure we put on, use, take off, and dispose of PPE and other disposable items appropriately as per the guidelines. Perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process
  8. Proper disinfection of equipment and surfaces is to be mandatorily followed. Diluted household bleach (5 tablespoons bleach per gallon-approx. 4 L of water) or alcohol solutions with at least 70% alcohol should be used to clean all equipment surfaces, room surfaces, door knobs, etc., and use a damp cloth soaked in disinfectant to clean surfaces (https://www.aao.org/headline/alert-important-coronavirus-context)

  9. Alcohol solutions with at least 70% alcohol/disinfectant wipes (wipes soaked in 70% isopropyl alcohol or 3% hydrogen peroxide) can be used to disinfect applanation tonometers, gonioscopes, slit-lamp lenses, etc.[2]

    • Wipe techniques: A prepared pad or gauze soaked in 70% isopropyl alcohol is applied to the tip of the Goldmann applanation prism for 10 s and the prism tip should be allowed to dry before use
    • Soak technique: Soak the tonometer head in 3% hydrogen peroxide or diluted household bleach (1:10 dilution). Soak the prism for 5–10 min between use, air dry for alcohol or irrigate tip with saline, and dry in case of sodium hypochlorite or hydrogen peroxide. The Schiotz tonometer should be dipped in a 1:1000 merthiolate solution and rinsed in saline/distilled water prior to use. Gonioscopes/PRP lenses should be cleaned in running water, wiped with gauze soaked in 70% isopropyl alcohol, and then dried before use. Koeppe and goniotomy lenses can be sterilized with ethylene oxide, prior to use in surgery. Strictly follow the manufacturer's instructions when applying, cleaning, and disinfecting ultrasound probes. Disconnect the probe from the ultrasound console and rinse the probe with a warm, nonabrasive soap and water solution. Meticulously scrub the probe as needed with a soft brush, sponge, or gauze pad to remove all residues.[3]

  10. Noncontact tonometers should be avoided as they can create microaerosols which can disperse the virus[4]
  11. Let us make sure that we take care of every patient who comes to us without discrimination, but taking adequate precautions to avoid threat to our health. All unnecessary appointments can be deferred till the pandemic is under control. Instruct patients to call and discuss the need to reschedule their appointment. Postpone elective procedures, surgeries, and nonurgent OP visits
  12. Let us avoid all gatherings for the time being, but make use of virtual platforms to disseminate information
  13. And, finally, most important, we must communicate and collaborate with public health authorities, help our coworkers and students follow the mandated guidelines, and give sickness benefits to staff suffering from symptoms that need quarantine.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Situation Report-52, Coronavirus Disease 2019 (COVID-19). Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. [Last accessed on 2020 Mar 12].  Back to cited text no. 1
Sood D, Honavar SG. Sterilisation of tonometers and gonioscopes. Indian J Ophthalmol 1998;46:113-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
Cordero I. Caring for A-and B-scans. Community Eye Health 2015;28:57.  Back to cited text no. 3
Britt JM, Clifton BC, Barnebey HS, Mills RP. Microaerosol formation in noncontact 'air-puff' tonometry. Arch Ophthalmol 1991;109:225-8.  Back to cited text no. 4

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