Spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known as the COVID-19 virus, through respiratory droplets has been confirmed.1 People who are in close contact with others are at risk of contamination with respiratory droplets. Airborne transmission possibly occurs in the setting of medical procedures with aerosol generation.2,3 COVID-19 might spread by touching a surface or object that has the virus on it, but this is not thought to be the main way the virus spreads.2,3 The World Health Organization recommends contact and droplet precautions, with eye or face protection to prevent the transmission of the disease.4 Regrettably, the Chinese whistleblower ophthalmologist has died because of coronavirus infection, after visiting infected patients.5 Ophthalmologists should be careful about personal protection during slitlamp examination because of close contact with patients' breath. As stated in the American Academy of Ophthalmology “Coronavirus Eye Safety” article, the virus can spread through the eyes and limiting eye exposure can help in prevention.6 Ophthalmologists should take care to protect themselves with goggles and a respiratory protective mask during slitlamp examination of patients with transmissible disorders; unfortunately, signs and symptoms of the COVID-19 infection are not evident in all infected patients. The built-in protective slitlamp breath shield could impede some airborne droplets, but the efficacy might be limited because of the small size of the shield. We prepared a wide-flexible breath shield as a simple device to enhance the personal protection of ophthalmologists during slitlamp biomicroscopy. The protective shield to interpose between the ophthalmologist and patient can be fashioned in the following steps:
Equipment: a nylon-based polyvinyl chloride (PVC) plastic sheet (we used A4, 210 × 297 mm, and 0.3 mm thick PVC film) (Figure 1, A), a pair of scissors, and a pen.
- Use the original slitlamp breath shield as a guide to draw the cut line (Figure 1, B).
- Cut the sheet to create a semicircular part to match the slitlamp biomicroscope (Figure 1, C).
- Pierce the sheet to create a hole for the screw (Figure 1, D).
- Mount the new, wide breath shield for more protection (Figure 2).
We used this shield on a Topcon SL-3D slitlamp, and it should fit similar instruments. Otherwise, it is possible to custom-cut a compatible shield for any slitlamp using the built-in breath shield as a model. The wide PVC sheet breath shield could increase the protection level for both the examiner and the patient. According to a recent report, the COVID-19 virus survives on the plastic surface up to about 72 hours; the virus might remain viable for a while on both the built-in breath shield and wide protective shield discussed in this article.7 It is recommended to follow protocols for safe examination and not to touch the shield before spraying it with an effective disinfectant solution. We use 70% ethanol to clean the chin rest and forehead strap after each visit, and we spray ethanol on the shield and other parts of the slitlamp after visiting any high-risk patient; the safety instructions might vary according to workplace policy and the severity of the epidemic. The sheet seems to limit the use of the applanation tonometer, but its flexibility allows the tonometer to swivel over the shield. Maximum protection is the first step to prevent transmission of COVID-19 to healthcare personnel. In this preliminary report, we describe a wide PVC sheet breath shield as a simple and inexpensive tool to enhance protection during slitlamp examination.
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2. Phan LT, Nguyen TV, Luong QC, Nguyen HT, Le HQ, Nguyen TT, Cao TM, Pham QD. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med 2020
3. Liu YC, Liao CH, Chang CF, Chou CC, Lin YR. A locally transmitted case of SARS-CoV-2 infection in Taiwan. N Engl J Med 2020
4. World Health Organization. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. 2020. Available at: vbs://www.who.int/publications-detail/infection-prevention-and-control-during-healthcare-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
. Accessed on February 04, 2020
5. Lee KJ. Coronavirus kills Chinese whistleblower ophthalmologist. 2020. Available at: https://www.aao.org/headline/coronavirus-kills-chinese-whistleblower-ophthalmol
. Accessed March 29, 2020
7. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lloyd-Smith JO, de Wit E, Munster VJ. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020