Carina Koppen MD, PhD, FEBO
While the risk of ocular transmission of 2019-nCoV may be small, contact lens practitioners and their patients need to take all necessary precautions to avoid the possibility of infection.
An editorial in Contact Lens and Anterior Eye noted that the impact of the coronavirus pandemic was “massive” since contact lens practitioners are exposed to potential infection with every patient because of close proximity to them. The editorial lists several steps that can be taken to reduce risk, including rescheduling non-emergency appointments and screening patients who may have been exposed. Other suggestions include using adequate personal protection equipment, careful disinfection of equipment and contact lens trial sets, along with thorough cleaning of all instruments.
The American Academy of Ophthalmology has gone so far as to recommend that patients stop wearing their contact lenses until the crisis passes, switching instead to spectacles. The AAO patient advisory notes that viral conjunctivitis is believed to occur in up to 3% of coronavirus patients. It explains that the virus can be spread by touching an infected eye.
Carina Koppen MD, PhD, FEBO, Secretary General of the European Contact Lens Society of Ophthalmologists, does not recommend that patients stop wearing contact lenses. She cited several sources supporting the safety of contact lens wear. For example, one advisory from the International Association of Contact Lens Educators emphasizes that “there is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens wear compared to spectacle lens wear”. Rather, patients should be advised to wash their hands properly before handling lenses and to avoid touching their face with dirty hands.
Dr Koppen, Senior Staff Member at the Antwerp University Hospital, Belgium, notes that her clinic is only seeing emergency cases, as is the case in most ophthalmic practices now. This serves to protect both the doctors and their patients.
The exception would be patients with bandage lenses who need a weekly or monthly check-up. An example of an emergency case would be if a contact lens wearer experiences redness, pain, photophobia or a decrease in vision, since these symptoms might suggest an infectious corneal ulceration, she told EuroTimes.
What are the chances of ocular transmission of the virus? A recent study in Ophthalmology from Singapore evaluated 64 tear samples collected from 17 COVID-19 patients. The samples were collected from three-to-20 days from the time of initial symptoms. Both viral culture and polymerase chain reaction test were negative in all cases.
Nonetheless, Dr Koppen cautioned: “It is not impossible. I think there is a case reported of contamination of the eye, then the development of conjunctivitis and finally fever a few days later.”
Dr Cheng-Wei Lu reported in a letter in The Lancet that a physician was infected by 2019-nCoV during an inspection in Wuhan, China. He was wearing a mask but no eye protection and developed conjunctivitis. However, conjunctival scrapings were not evaluated at the time.
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