7.4 Special Precautions

7.4.1 Disinfection of Ophthalmic Instruments

 

General equipment

1. Slit-lamp
2. Non-contact tonometer
3. Autorefractor

• Disinfect with 70-75% ethanol or isopropyl alcohol immediately after each patient

 

Instruments that had direct contact with patient’s ocular surface

1. Goldmann applanation tonometer prisms
2. Diagnostic contact lenses

• Disinfect by immersion in either 1:10 diluted bleach solution with sodium hypochlorite or 3% hydrogen peroxide for at least 5 minutes. 

 

Other surgical instruments

• Sterilized according to standard protocols.

 

7.4.2 Risk with Non-contact Tonometry (NCT)

• The air jet impacted on the tear film was reported to generate micro-aerosols. 
• SARS-CoV-2 was reported to be present in tears and conjunctival secretions from COVID-19 confirmed patients with conjunctivitis
• Extra caution in patients with red eyes
• Operators should wear proper face mask or respirator
• Alternative methods to NCT: rebound tonometry

 

7.4.3 Ophthalmic Operations

General cases

• Surgical mask should be worn by all patients entering operating rooms
• Adhesive tape could be applied across the nose bridge area to ensure complete coverage of patient’s nose and mouth
• Require patients changing their clothes and putting on surgical caps

 

Suspected respiratory infection cases (urgent operations)

• Scheduled as last case of operation
• Thorough disinfection afterwards
• Be cautious and vigilant against sharp needles or blades injury

 

High risk or confirmed cases

• Refer to hospitals that have adequate facilities such as negative-pressure isolation rooms 

References
Britt JM, Clifton BC, Barnebey HS & Mills RP (1991): Microaerosol Formation in Noncontact ‘Air-Puff’ Tonometry. Archives of Ophthalmology 109: 225-228.
李纯纯, 唐媛, 陈张艳, et al. 非接触式眼压计测量产生气溶胶密度变化及其对疫情防护的意义.中华实验眼科杂志. In press.