key: cord-0698760-5l8a0oaq
authors: Montericcio, Alberto; Montericcio, Alessio; Raimondi, Raffaele
title: A Customized Face-Shield for Ophthalmologists During COVID-19 Second Wave
date: 2020-01-04
journal: Ophthalmic Plast Reconstr Surg
DOI: 10.1097/iop.0000000000001900
sha: 07e1b7421045f88537740bd833081570ae3dcf27
doc_id: 698760
cord_uid: 5l8a0oaq

nan

Second Wave

To the Editor: SARS-CoV-2 is known to be primarily transmitted through droplet spread and contact routes; however, other routes as airborne are considered possible. 1, 2 There are studies reporting that SARS-CoV-2 can be detected in the conjunctival secretions of positive patients with conjunctivitis. 3 Ophthalmologists are a high-risk category, because they have close contact with patients during the examination and are exposed to different potentially contaminated fluids as droplets, airborne, tears, and conjunctival secretions. As the contagion curve is rapidly increasing, personal protective equipment is essential to minimize viral spread and ensure safety. As far as eye protection is concerned, to prevent mucous membrane exposure, ophthalmologists can use goggles with good adhesion to the face or disposable face shields. 4 However, goggles may fog easily, do not ensure splash or spray protection to other parts of the face and are uncomfortable with prolonged use. 5 Regular corrective spectacles cover only a small area and are not considered adequate eye protection. 6 Face shields offer a defense from acutely expelled fluids and are commonly used as an alternative to goggles as they provide protection to a wider area of the face. 7 Protection from contamination of the surface of respirators can be prevented by placing a surgical mask over it, or wearing a face shield. 8 Evidence demonstrates the use of a cleanable face shield is strongly preferred to a surgical mask to reduce respirator contaminator. 9 Lindsley et al. 10 described respectively 96% and 92% decreases in the risk of inhalational exposure immediately after a cough for a face shield at distances of 46 and 183 cm. However, googles and conventional face shields may prove to be uncomfortable for ophthalmologists especially when using examination instruments as slit-lamp. Therefore, to warrant performance and protection, the authors decided to customize a commercially available headband (TO-5137809, Toolcraft, Germany) that comes with LED lighting and magnification lens (1.2×, 1.8×, 2.5×, and 3.5×) that is suitable for different professionals as dentists, jewelry makers, etc. The authors are delighted to share practical instruction to build this shield hoping it can protect the authors' colleagues during their activity.

In particular, the authors modified the provided lenses adding, with 2 M3 12-mm screws and nuts, a 3-mm-thick, 8-cm-high, and 18-cm-wide plexiglass. Plexiglass and lenses were previously customized respectively with a CO 2 laser cutter and drill press to shape 2 corresponding M3 holes. The plexiglass holes distance were 5 cm from the margins and 8 cm apart. Lenses are already fitted by the manufacturer to be attached to the headband and thus the plexiglass will follow along.

The result is a practical face shield with built-in magnification lens and LED light illumination that allows a safe close patient inspection, examination of lacrimal system, performance of Ophthalmic plastic and episcleral surgery. Moreover, it can be easily lifted up to 180° to comfortably use slit lamp and other instruments, such as surgical microscopes, which may reveal uncomfortable with other eyes protection (Fig.) .

During COVID-19 pandemic, ophthalmologists may benefit in their practice of this simple, economical, and customized face shield. 

Coronavirus (COVID-19)-10 de mayo 2020

Virtual ophthalmology: telemedicine in a COVID-19 era

Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations

Facing COVID-19 in ophthalmology department

Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection

European Centre for Disease Prevention and Control. Guidelines for Non-pharmaceutical Interventions to Reduce the Impact of COVID-19 in the EU/EEA and the UK. 24

Safety of goggles vs. face shields in the COVID-19 era

COVID-19: infection prevention and control guidance

Face shields for infection control: a review

Reusability of Facemasks During an Influenza Pandemic: Facing the Flu

Effect of surgical masks worn concurrently over N95 filtering facepiece respirators: extended service life versus increased user burden

Efficacy of face shields against cough aerosol droplets from a cough simulator

Correspondence: Alessio Montericcio, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy (alessiomontericcio@gmail.com)The authors have no financial or conflicts of interest to disclose. 

Reconstruction"To the Editor:The authors have read with interest the paper published by Madhan and Cho, 1 the first report of abnormal parasympathetic lacrimal gland innervation caused by dislocated orbital implant. Here, the authors would share 2 similar, but a bit different cases.From January 2015 to December 2019, the authors' team has repaired 2051 cases of orbital fracture, except for those with severe craniocerebral injury or facial nerve injury. Among them, 2 cases were unable to produce tears when crying, but without sunken eyeball, diplopia, or any other complications after operation. The 2 cases had no dry eye symptom or corneal epithelial detachment. Also, the Schirmer test and the tear film break-up