Table 3.

Eyelid tumors-disease specific guidelines for ocular oncology services during SARS-Cov-2/COVID-19 pandemic

Ocular Tumors	Standard of Care	COVID-19 guidelines	Challenges	Comments
1. Malignant Eyelid Tumors
Diagnosis	Clinical evaluation CTscan/MRI if indicated	No delay in diagnosis	Risks of COVID-19 transmission	Patient and health care worker protection as per guidelines in the clinic and operation theatre
Primary Treatment	Surgical excision with margin clearance	No delay in the management of malignant eyelid lid tumorsAvoid 2 staged eyelid reconstructive procedure	Surgical exposure to aerosols LA preferredAvoid electrosurgery (diathermy cautery) Fresh specimen for frozen section to be transported carefully	Operation theatre safety guidelines strictly followed. Pathologist informed prior if frozen section/FNAC
	Chemoradiation	No delay if indicated	Associated risk in older patients	Professionally monitored personal protection. Out-patient chemo suits
	Sentinal lymph node biopsy	Delayed by 4 to 6 weeks	Procedure associated risks	Performed by head and neck surgeon
Follow-up	Clinical evaluation Teleophthalmology	Post-operative delayed for 4 to 6 weeks If stable can be delayed by 3 months in the first 1 year If stable after 1 year can be delayed by 6 months	Post-surgical complications Early detection of recurrence	Transfer of care locally
2. Benign Eyelid Tumors
Diagnosis	Clinical examination/Teleophthalmology	Confirm the diagnosis	Malignant lesions can mimic benign or inflammatory eyelid lesion Avoid misdiagnosis especially in teleophthalmology	Look for alarming signs Review with ophthalmologists locally
Primary management	Observation Surgical excision	Surgery delayed until and after the pandemic	Cosmetic concern of patient	Patient counseling regarding risks vs benefits

CT – Computerized tomography; MRI – Magnetic resonance imaging