A Customized Face-Shield for Ophthalmologists During COVID-19 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 CO₂ 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.).

Customized face shield for ophthalmologists (A) in operative position, (B) 90° tilted, and (C) 180° tilted.

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