key: cord-0754843-7wjrmhzb
authors: Paul, Anujeet; Sainath, Dipika; Krishnagopal, Srikanth
title: Recommendations for management of ocular symptoms due to prolonged use of personal protective equipment by healthcare workers
date: 2021-10-03
journal: Indian J Ophthalmol
DOI: 10.4103/ijo.ijo_1414_21
sha: 98c5b78cd77d3c5d30bc5060877279a089395a36
doc_id: 754843
cord_uid: 7wjrmhzb

nan

Dear Editor, With India being the second highest country in the world affected by the coronavirus (COVID-19) pandemic, a majority of healthcare workers are spending prolonged hours in COVID-19 wards donned in a personal protective equipment (PPE). [1] The authors noticed an increasing number of healthcare workers coming to the Ophthalmology outpatient department with complaints of ocular irritation or redness specifically after COVID-19 ward or COVID-19 intensive care unit postings. We thereby evaluated the incidence of symptoms via an online questionnaire-based survey (via Google Forms) for all healthcare workers using PPE over the duration of 1 month. The data was analyzed and the following results were obtained.

A total of 254 responses from interns, postgraduates, staff nurses, and general attenders who donned a PPE were received, cross-checked, tabulated, and analyzed. The median age of the respondents was 27 (IQR: 24,32) years. They were categorized into four groups depending on the duration they were donned in a PPE, namely, less than or equal to 6 h, less than or equal to 8 h, less than or equal to 10 h, and less than or equal to 12 h as well as the number of consecutive days they were donned in. The study period ranged from 4/15/21 to 5/15/21.

In our survey, 52.7% (120) were males and 47.3% (134) were females, while 50.39% (128) were postgraduates, 22% (56) were staff nurses, 22.4% (57) were attenders, and 5.1% (13) were interns. The maximum duration donned in was less than or equal to 8 h by 31.6% (80) of the respondents followed by less than or equal to 10 h and less than or equal to 12 h by 26.5% (67) and 24.4% (62) of the respondents, respectively. Of these, 62.4% (158) respondents were donned in for 7 days consecutively, followed by 27.4% (70) who were donned in for 5 days consecutively [ Figs. 1 and 2] .

When asked about prior ocular conditions, 35.9% (91) revealed that had preexisting dry eye and 24.8% (63) said they had bouts of allergic conjunctivitis, while 24.8% (63) had no diagnosed ocular condition. Among lesser observed were refractive errors and history of prior refractive surgery. When asked specifically about ocular symptoms after doffing from their PPE, 34.2% (87) complained of ocular itching, 24.8% (63) complained of ocular irritation, 23.9% (61) complained of watering, 23.1% (59) complained of redness, 21.4% (54) complained of ocular soreness, 20.5% (52) complained of foreign body sensation, and 29.1% (74) had no specific ocular complaint [ Fig. 3 ]. Among respondents having ocular symptoms after doffing, 43.6% (111) stated their symptoms subsided in a few hours, while 26.5% (67) stated that it took a few days. When asked about whether they consulted an ophthalmologist for their symptoms, 25.6% (65) said they did, while 32.5% (83) either self-medicated or took medication as per their ophthalmologists' recommendation.

The ocular surface is neutral to mildly acidic (pH = 7.11 ± 1.5) and sweat, which is primarily acidic (pH = 6.3 ± 1.5) and may percolate onto the ocular surface. [2, 3] We postulate that prolonged hours in a PPE hinders a healthcare worker from removing the sweat from the ocular surface, thereby allowing the sweat that percolates to change the pH and play a role as an ocular irritant. This is supported by the results collected where only 29.1% participants stated that they had no specific ocular complaint after doffing. Additionally, those donned in for longer hours (less than or equal to 8 and 10 h) had at least one ocular symptom.

For healthcare workers spending prolonged hours in PPE, ophthalmologists may consider prescribing preservative free artificial tears solutions after doffing to dilute the ocular surface, thereby restoring the normal ocular pH. Alongside, any preexisting ocular condition that may affect the ocular surface health should be taken into consideration as it may play a role in aggravation of symptoms. We also urge public health guidelines to contemplate including a provision for management of post-PPE doffing ocular symptoms for healthcare workers.

Assessment of compliance and adherence to wearing masks and perceived severity and susceptibility of acquiring COVID-19 in patients reporting to an ophthalmology casualty in India

Dear Editor,

The use of diagnostic lenses is an important part of the clinical evaluation of posterior segment in ophthalmology. Lens fogging has been an associated menace, which has got aggravated with the use of protective masks by patents in the COVID-19 era. The warm air from patients' breath is redirected to the lens surface which gets condensed on the lens surface obstructing viewing [ Fig. 1a] . A lot of methods, such as using an antifogging spray, fan, and making patients wear antifogging-band, have been used to curb this menace. [1] [2] [3] Here we describe a (polyvinyl chloride) deflector that can prevent fogging of lenses during evaluation. A one-inch diameter PVC pipe is taken. It is cut into small pieces of 10 mm