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Online conference: COVID-19 and eye care in African Eye Units: Preventing transmission of COVID-19 in the eye unit. By Elanor Watts, 9 April 2020

On 9 April 2020, the International Centre for Eye Health ( and the Royal College of Ophthalmologists ( hosted an online conference for over 270 eye health professionals to discuss the most recent COVID-19 guidelines and protocols and share their experience. In this presentation, Elanor Watts discusses the guidelines and practical aspects of preventing transmission of COVID-19 in the eye unit. London, UK. 9 April 2020.

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The Community Eye Health Journal ( also published a detailed article on 9 April, called 'How to protect yourself and your patients from COVID-19 in eye care.' Read it here:

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Online conference: COVID-19 and eye care in African Eye Units: Preventing transmission of COVID-19 in the eye unit. By Elanor Watts, 9 April 2020

  1. 1. Preventing Transmission of COVID-19 in the Eye Unit Dr ElanorWatts, BA BMBCh Current MSc Student – Public Health for Eye Care, LSHTM
  2. 2. On Arrival to the Clinic
  3. 3. Before the Patient Enters – Triage Source:Laietal.–TheHongKongGuidelines Ayebareetal.–AdoptionofCOVID-19triagestrategies forlow-incomesettings
  4. 4. Before the Patient Enters - Triage
  5. 5. • Wash hands for at least 20 seconds with soap and water, or hand gel (>60% ethanol or 70% isopropanol) • Everyone on arrival to the clinic (including patients and escorts) • Before and after every patient, putting on or taking off PPE On Arrival – Hand Hygiene ImageSource:WHO
  6. 6. • Keep waiting rooms well ventilated if possible • Reduce numbers of patients in waiting rooms, with ideally 2m between waiting patients – No visitors, and no more escorts than necessary On Arrival – Distancing Imagesource:RippleAfrica
  7. 7. In the Clinic – Types of Face Mask Image sources:,,,, Fluid-resistant surgical mask Homemade fabric mask Filtering facepiece (FFP) 2 respirator ≈ N95 FFP3
  8. 8. Fit testing the FFP Image sources: HSE and CDC
  9. 9. RCOphth Guidelines
  10. 10. Personal Protective Equipment Imagesource:PublicHealthEnglandposter–COVID-19SafeWaysofWorking,Avisualguidetosafe PPE Order for Putting on PPE 1. Gather PPE 2. Hand hygiene 3. Gown/apron 4. Mask/respirator 5. Goggles/face shield 6. Gloves Order for Removing PPE 1. Gloves 2. Goggles/face shield 3. Gown/apron 4. Mask/respirator without touching the front 5. Wash hands immediately If hands become contaminated at any point, wash High risk of contamination when taking off PPE if done incorrectly
  11. 11. • Instructions for making a breath guard from e.g. old X-ray films/acetate are available at: – RCOphth guidance – VariousYouTube videos e.g. • Free slit lamp breath shields are being offered by: – Zeiss ( – currently only shipping to EU, UK, USA, Canada, Singapore, Malaysia, Thailand, Vietnam, Philippines, and Indonesia – Topcon – to current customers ( Slit Lamp Breath Guards ImageSource:RCOphth ImageSource:Zeiss
  12. 12. Are we following this guidance in the UK? – BEECS survey
  13. 13. • ?Patients wear masks • Goggles can be decontaminated with detergent AND hospital disinfectantAND clean water/alcohol, and re-used • Face shields/visors, and slit lamp guards, can be home made • Hand gel can be made locally, from: ethanol (or isopropyl alcohol), hydrogen peroxide, and glycerol • If no disposable isolation gowns are available, alternatives include disposable lab coats, washable gowns/coats • Lots of guidance available onCDC website (see last slide) Applying the Guidance to Different Settings: e.g. What if we run out? Image source: WHO
  14. 14. 1)Take measurements: - temple to temple -head circumference - forehead/brow to sternal region 2) Cut transparent material using measurements above. It should cover Rt to Lt temple (width) and forehead to chest (length) 3) Cut the belt (length is 15cm+head circumference), then into two equal halves. 4) Place material on a flat clean surface 5) Staple/stitch belts to both upper ends of the material 6) Cut soft foam/fibre (about 4cm wide and long enough to cover forehead) - this is for comfort on the forehead skin Making Face Shields - UITH, Nigeria ImageSource:UITH,Ilorin
  15. 15. • Don’t shake hands/hug • Look through notes/find out history before patient comes into room • Remain 2m away from patient when possible • Only do pertinent parts of examination, and when close to patient for examination, ask them not to speak unless necessary, and to touch the examination equipment as little as possible • Use single-dose eye drops • AVOID: • Air puff tonometry – only do tonometry if needed, and ideally use e.g.Tonopen/i-Care/Goldmann with disposable tip • Direct ophthalmoscopy – use indirect • Close examination for longer than necessary, inc. investigations • General anaesthetic (= aerosol-generating procedure), unless essential • Nasal endoscopy Examining the Patient
  16. 16. • Wear disposable gloves to clean • Recommended disinfectants include: • Diluted household bleach (5tbsp per gallon of water) • OR at least 70% alcohol • OR various household cleaning products, verified to kill viruses • Clean: • Surfaces in the room, inc. door handles, panels, phones • Examination equipment, inc. the slit lamp, breath shield, controls, handles and chin/forehead rest • Tonometer tip (while 70% alcohol will not sterilize against adenovirus, it will against SARS-CoV-2) After each interaction – Cleaning Surfaces Source: Spanish Society of Ophthalmology Guidelines
  17. 17. • CEHJ article - Protecting yourself and your patients from COVID-19 in eye care • RCOphth guidance: PPE and staff protection requirements for ophthalmology. guidance-PHE-compliant-WEB-COPY-030420-FINAL.pdf • WHO Guide to Local Production ofWHO-recommended Handrub Formulations • CDC Strategies to Optimize the Supply of PPE and Equipment • WHO Rational use of personal protective equipment for coronavirus disease (COVID-19). nCoV-IPCPPE_use-2020.2-eng.pdf Useful sources of information