COVID 19 and contact lenses - Dr Lucio Buratto

The virus circulates in the air and infects mainly through small droplets released from the nose and mouth of an infected person while coughing or sneezing. A single cough/sneeze can produce up to 3,000 droplets. Even in speaking, droplets are emitted but in a much lower quantity. These droplets containing the virus can reach other people's body parts, on clothing and surrounding surfaces, but some smaller particles can remain in the air, albeit in reduced concentration and therefore at low infectious risk. However, it is advisable to always keep the safety distance of at least one and a half meter.Studies report that the virus remains on different surfaces for a long time; it would be active for six hours on stainless steel and seven hours on plastic; it should be immediately specified that the only contact lenses made of a plastic monomer are rigid contact lenses, which are currently less used. Without scientific information on virus persistence on hydrophilic materials (soft contact lenses) or on other polymers (used for rigid gas-permeable contact lenses), although to date there is no evidence that people can be infected through contact lenses, some precautions should be observed for the pandemic period, pending further scientific data.In fact, a contact lens user is potentially more susceptible to infection for at least three reasons: because hands can bring the virus to the eye; because the cough/sneeze of an infected person located nearby (less than 1.5 meter) can carry the virus on the contact lens through the droplets emitted into the air.And finally, because the conjunctiva is one of the preferential ways of penetration for the virus into the body. These conditions are exacerbated in environments where positive patients are hospitalized. A) Protection for contact lens practitioners It is recommended to suspend the fitting activity until the risk of contamination ceases; if it is necessary to perform contact practice, take at least the following precautions: - Personnel responsible for contact lens application must wear special surgical masks, protective glasses, or specific protective visor, disposable waterproof gloves. - Wash hands with appropriate alcohol-based cleaning solutions before and after contact with each patient, even if gloves are used during the various procedures. - Wash hands before inserting gloves and perform all maneuvers on the patient with gloves; then, after removing the gloves, wash hands again. - Pay attention during the gloves removal maneuver, because there is a high risk of contamination. - Thoroughly clean all the instruments used in the clinical practice:• trial frame• trial lenses• instruments’ chinrest and headrest - The slit lamp must be equipped with a special protective screen; if you have a digital slit lamp equipped with a video system, it is preferable to use this. Important information for trial contact lens use - Soft contact lenses: use only disposable lenses taken from sterile packaging - Trial gas-permeable (RGP) contact lenses: use only sealed lenses for the fitting test and proceed with the definitive lenses (also in sterile packaging). - Referring to Gas Permeable lenses, preferably use lenses produced with fluoropolymer. - The contact lens that the patient will fit must be contained in sealed packages B) Warnings for contact lens wearers Contact lens wearers must follow new rules in order to protect themselves from contagion and it is appropriate that the new instructions are provided in a written form. - Wash hands thoroughly with an alcohol-based detergent before fitting contact lenses. - Always wash hands, with the alcohol-based detergent, during the procedure between one eye and the other one. - Wash hands thoroughly after finished the contact lens fitting procedure. - Wash hands thoroughly after removing the contact lenses. - Alternatively, use disposable latex gloves to apply and remove contact lenses. - Perform the procedures for applying and removing contact lenses on a disposable drape and then discard it. - Where possible, always use disposable dailies contact lenses and always discard it at the end of the wear. - Avoid touching nose, mouth during contact lens fitting or removal procedures. - Respect the expiration dates of contact lenses, in the case of frequent replacement contact lenses. If weekly or monthly contact lenses are used: - Disinfect contact lenses with hydrogen peroxide solutions with a special catalyst container. - Do not use multipurpose preservative solutions. - Do not use multipurpose saline solutions. - Change the contact lens container frequently. - Perform cleaning with enzymatic tablets once a week, in order to avoid the adhesion of the mucoprotein deposits, on which substrate easily contaminating agents settle. - In case of artificial tears use, preferably choose single dose products. - Suspend contact lenses in case of eye redness. -Suspend contact lenses in case of flu symptoms (fever, cough, muscle pain, absence of taste and smell and others) Glasses The virus can also be deposited on the surfaces of glasses if used in a contaminated environment; therefore, try to avoid touching glasses and wash hands frequently and often wash glasses with liquid neutral soap (supplied by non-contact dispenser) avoiding damages to the lenses.  Change the glasses case frequently. C) Warnings for Ophthalmologists - Remind contact lens wearers to follow all the hygiene rules contained in this document. - Recommend to preferably use, during this pandemic period, glasses and in any case suggest to sanitize them frequently. - Prescribe disposable contact lenses when the customized contact lenses fitting is not necessary. - Recommend the patient to suspend the contact lens use in case of eye redness or eye problems. - Suspend contact lenses in case of flu symptoms. - During the pandemic period, recommend not to touch the nose and mouth but above all the eyes with the hands and even more so in the presence of contact lenses. Further information - Preferably use disposable contact lenses.-Never reuse disposable contact lenses the next day. -Never touch contact lenses with mouth. -Never clean contact lenses with saliva. -Avoid using nail polishes during this period, because bacteria and viruses proliferate easily under the nail polishes. Environmental ventilation is important in this period especially in environments with several people, even if they are at a distance of one meter from each other.Ventilate the rooms before staying there.In artificially ventilated rooms, it is recommended to periodically perform checks or replace filters, since the virus tends to survive in humid places.  Warnings for doctors and healthcare professionals operating in environments with COVID positive patients - Patients with COVID-19 should not wear contact lenses but should preferably use glasses - Staff (doctors, nurses and others) who work in infected environments are preferable to use glasses; contact lens wearers must always use protective glasses or a protective screen and wash hands frequently - Air the rooms frequently - Follow the general hygiene rules relating to the prevention of infection  

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