Message from the BEECS COMMITTEE
BEECS would like to commend our emergency eye care colleagues for the work they are carrying out in hospitals and primary care in the UK. Departments have seen a huge reduction in routine ophthalmology work and their trainees redeployed to medical front line services.
Ophthalmology departments have now concentrated their resources into providing emergency eye care and interventions for sight-threatening eye conditions. We have seen public health statements put out via social media and BBC educating the public about preventing eye injuries, reducing contact lens wear and giving advice about conjunctivitis. However, there are anecdotal reports of a dramatic decline in the presentation of certain emergency conditions such as retinal detachment, compared to before the lock down period.
We have updated our recommendations below for emergency eye care staff and AHP, after reviewing the scientific literature, official guidance (including that from the Royal College of Ophthalmologists) and numerous anecdotal reports.
Hospital emergency eye clinics
- Only genuine ocular emergencies should be seen in the hospital, however, consider virtual means for assessment for any patient where possible
- Assign a pre-triage area to screen for high risk patients, with a 2 metre distance (see example below), screening personnel wearing a fluid resistant mask or a physical barrier/screen at the reception desk
- High risk and COVID-19 positive patients should wear a fluid resistant (surgical mask).
- Strongly consider fluid resistant masks for all patients to prevent virus spread
- Assign COVID-19 isolation examination rooms with provision for PPE
- High risk patients with an ocular emergency should be isolated, seen at once by the most senior clinician or NP, managed and discharged swiftly with minimal time on the slit lamp
- Patients who have no immediate threat to vision should be dealt with outside the hospital setting
- High risk patients with no immediate threat to vision should leave the department and isolate as per Public Health England advice
Protection for Ophthalmologists and AHPs working in hospital emergency eye clinics
- Ophthalmologists need FFP3 mask fitting to enable sight saving surgery and review of patients on COVID-19 wards/ITU
- Strict hand hygiene must be maintained for all examinations by all staff
- Scrubs should be worn in hospital settings, along with gloves, goggles and a fluid resistant mask. A plastic apron should be used where scrubs are not available.
- All slit lamp, lasers and imaging modalities that a patient rests on shouldhave a substantial guard fitted, which should be disinfected after each examination
- Use of contact lenses and tonometer attachments (including tonohead mounts) e.g. gonioscopes, laser lenses, shouldbe used for emergency cases where essential and disinfected after each examination
- Full PPE (FFP3, long sleeved gown, gloves and eye protection) is required forocular surgery in high risk and COVID-19 positive patients in an assigned COVID-19 operating theatre for both GA and LA cases, where possible.
- General anaesthesia should be avoided where possible and reserved for emergency sight saving cases where local anaesthesia cannot be performed
The next few weeks will be a challenging time for us all at the peak of the curve. BEECS will continue to be a base for sharing resources. We are confident you will continue to provide a high standard of emergency eye care and implement stringent infection control measures to protect your staff and patients.
We wish all who have COVID-19 a swift recovery and with heartfelt sympathies to all that have passed due to it. BEECS
– 14th APRIL 2020