A simple and effective protective shield for the ophthalmoscope to prevent COVID‐19

Dear Editor,

The ophthalmoscope is one of the most common instruments used by medical professionals. It can be used to perform the Brückner test and Hirschberg test, to check the pupillary reflex, and to examine the fundus. However, the ophthalmologist's face is prone to exposure to a patient's sneeze or cough. The emergence of the coronavirus disease (COVID‐19) has challenged the current healthcare system. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) can be transmitted through virus‐containing droplets from infected patients, regardless of whether the patient is symptomatic. ¹ The virus‐containing respiratory droplets propelled toward physicians and other examiners expose them to the infection, even if those patients are wearing a mask; furthermore, it is especially difficult for young children and some patients with special needs to wear masks. ² During the COVID‐19 pandemic, proper protection during practice is highly recommended. ³

In Taiwan, no severe outbreak has occurred; however, strict triage is being performed at the entrance of the hospital before any medical treatment is administered. In some countries, non‐essential services have been temporarily closed. However, ophthalmologists are still in close contact with high‐risk patients. ⁴ We propose a simple and low‐cost protective shield for the ophthalmoscope to prevent the spray of droplets from reaching the examiner's face. An overhead transparency (size A4), stapler, staples, hook and loop fasteners (Velcro), scissors, and a box cutter are required to create this shield. The basic construction of the shield is shown in Figure 1. A rectangular hole corresponding to the viewing window of the ophthalmoscope is cut to prevent light reflecting or scattering from the transparent film. The hook and loop fasteners are tailored to the size of the ophthalmoscope and stapled to the transparency. The use of a scrub cap along with the shield could result in even fewer droplets reaching the face and head. Furthermore, the size of the transparency could be increased (eg, from A4 to B4) to increase the protected area. Additionally, a protective shield could be made in a similar manner for the retinoscope and portable slit‐lamp (Figures S1 and S2).

FIGURE 1.

Drawings showing the basic structure of a shield comprising an overhead transparency, fixation straps (hook and loop fastener to hold and fixate the ophthalmoscope), A, and a rectangular hole (optional) as the viewing window, B. The completed protective shield for the ophthalmoscope, C

A face shield or eye goggles are commonly used for protection against droplets from patients; however, they could cause changes in the reflective interface and light‐scattering or image distortion. Our design prevents these interferences and offers practical protection at the same time. Depending on the material chosen, the shield could be disposable or reusable after proper sterilization with 75% alcohol. Caution should be taken when creating the hole in the transparency used for the viewing window of the ophthalmoscope; it should not be large enough to allow droplets pass through it. Using a tape to seal the gap between the ophthalmoscope and shield is recommended. We sincerely hope this small and useful invention could protect our colleagues from exposure to droplets and infections.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

Supporting information

Data S1 Supporting Information