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Expedited Publication, Photo Essay

iOpener – A novel device during COVID-19 pandemic

Jaiswal, Kulharsh B; Sonawane, Nikita1; Vedhachalam, Rajesh; Jain, Nikhil; Venkatesh, Rengaraj2

Author Information
Indian Journal of Ophthalmology: August 2021 - Volume 69 - Issue 8 - p 2226
doi: 10.4103/ijo.IJO_915_21
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Slit-lamp examination is inevitable part of ophthalmic examination. During COVID-19 pandemic, both patient and doctors safety are utmost important. Ophthalmologist comes in close contact with ocular surface during slit-lamp examination. Various organizations have produced guidelines regarding the use of PPE to reduce the risk of exposure for prevention of COVID-19 spread.[12] While examining patients for foreign body, conjunctivitis, chemical injury, postoperative follow-up, anterior uveitis, or during indirect ophthalmology, we need to retract eyelids. There are numerous possibilities of gloves getting exposed to infectious tears[3] or contaminated by accidently touching face mask. This can lead to cross infection of slit-lamp knobs, keyboard while entering in electronic medical record or surrounding surfaces, before changing gloves. To avoid this, various ideas like speculum[4] or cotton bud are used.

To alleviate this, we came up with novel 3D-printed iOpener. A “V”-shaped self-recoiling retractor with each prongs measuring 7 cm in length, 1 cm wide, and angled at 50° with a hole of 1 cm × 1 mm at the anterior end of the prongs to accommodate the cut ends of buds was designed using solid-works software (Dassault systems). It was then 3D-printed using flexible thermoplastic polyurethane material[5] on Ultimaker 3D printer (Netherlands).

A single sterile cotton bud is cut in two and placed at anterior end of retractor. Device does not require use of topical anesthesia. During slit-lamp examination, the prongs with buds are approximated and placed over the skin of lower eyelid in up gaze, upper eyelid in down gaze, and then prongs are released. Due to material’s recoil memory, it opens the eyelid widely without coming in contact with ocular surface. Since it is very light weight, it rests over eyelids as external speculum [Fig. 1]. The same procedure is repeated for other eye. For next patient, the device is cleaned with 70% isopropyl alcohol and cotton buds are replaced. The only limitation of device is lid eversion.

Figure 1
Figure 1:
(a) iOpener with sterile cotton buds, (b) iOpener resting over eye lids as an external speculum while examining conjunctivits patient, (c) iOpener assisted corneal foreign body removal and (d) iOpener assisted corneal scrapping.

iOpener is a novel device which is easy to use, cost effective, patient friendly, reusable, universal, and safe during COVID-19 pandemic. It can also be used during the post COVID-19 period as new normal making it a new tool in ophthalmologist armamentarium.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1. PPE and Staff Protection Requirements for Ophthalmology 9th April 2020. https://www.rcophth.ac.uk/wp-content/uploads/2020/04/UPDATED-RCOphth-PPE-for-ophthalmology-090420.pdf
2. Sengupta S, Honavar SG, Sachdev MS, Sharma N, Kumar A, Ram J, et al All India ophthalmological society –Indian journal of ophthalmology consensus statement on preferred practices during the COVID-19 pandemic Indian J Ophthalmol. 2020;68:711–24
3. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection J Med Virol. 2020;92:589–94
4. Aishwarya A, Gupta P, Tiwari US. Wire lid retractor –A new use of wire eye speculum Indian J Ophthalmol. 2019;67:391–2
5. Barmouz M, Behravesh AH. Shape memory behaviors in cylindrical shell pla/tpu-cellulose nanofiber bio-nanocomposites:Analytical and experimental assessment Compos Part A Appl Sci Manuf. 2017;101:160–72
Keywords:

3D printing; COVID-19; innovation; iOpener; External speculum

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