Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the use of breath shields in the prevention of respiratory droplet transmissions has been discussed and accepted as the preferred practice for ophthalmic examinations. In addition to wearing proper personal protective equipment (PPE), ophthalmologists must form a barrier between themselves and the patient to further minimize airborne droplets from entering the eyes. The most commonly used barriers are built-in acrylic breath shields, self-made or customized X-ray film breath shields or flexible polyvinyl chloride (PVC) plastic sheet breath shields. The efficacy of breath shields in providing additional protection is well proven. However, exact position of the placement of breath shield between the patient and the examiner to reduce virus spread is still not very clear. We believe that, owing to the small size of these breath shields and their proximity towards the ophthalmologist and not the patient, it may limit their protective effect in preventing the aerosols and droplet spread. To tackle this, we have used the face shield to act as a barrier during ophthalmic examinations, which is economical and readily available.
The commonly available face shield made from polycarbonate is used. Its protective film is removed and it is cleaned thoroughly with an alcohol swab. The elastic band of the face shield at one side is cut and the face shield is placed just above the headrest position [Fig. 1a and b]. The headrest provides stability to the face shield. An elastic band is then tied up at left side of the slit lamp. A small area of foam is detached from the face shield and is clipped together with the other side of the patient’s positioning arm for tight placement [Fig. 1c]. This covers the entire space of the patient examining area of the slit lamp, from the headrest to the chinrest. This placement of a face shield provides a barrier in slit-lamp examination from the patient’s side [Fig. 2]. It is very inexpensive, requires nil items, and can be easily installed in any slit lamp. Authors didn’t find any issues while examining the patients. However, small, subtle findings can be missed, like occasional cell and flare grade 1.
To conclude, in ophthalmic settings, we must be cautious and examine each and every patient as if they are an asymptomatic SARS-CoV-2 transmitter, necessitating maximum protection for the examining ophthalmologist, which can be better provided by this barrier method using a face shield during the slit-lamp examination.
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