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VIEWPOINT
Year : 2020  |  Volume : 151  |  Issue : 5  |  Page : 392-394

Contact lens use at the time of SARS-CoV-2 pandemic for healthcare workers


Department of Endocrinology & Diabetes Mellitus, The Whittington Health NHS Trust, Magdala Avenue, London, United Kingdom

Date of Web Publication20-Jun-2020

Correspondence Address:
Raghav Bhargava
Department of Endocrinology & Diabetes Mellitus, The Whittington Health NHS Trust, Magdala Avenue, London
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1492_20

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How to cite this article:
Bhargava R. Contact lens use at the time of SARS-CoV-2 pandemic for healthcare workers. Indian J Med Res 2020;151:392-4

How to cite this URL:
Bhargava R. Contact lens use at the time of SARS-CoV-2 pandemic for healthcare workers. Indian J Med Res [serial online] 2020 [cited 2020 Jul 7];151:392-4. Available from: http://www.ijmr.org.in/text.asp?2020/151/5/392/284854



There are around a 140 million contact lens users in the world[1]. The number is globally increasing every year due to ease of availability, low pricing options, improvement in vision without affecting physical appearance, non-interference with many sports and other activities and enhancement of quality of life[2]. These also apply to healthcare workers (HCWs), particularly with reference to coronavirus disease 2019 (COVID-19). The World Health Organization (WHO) declared it as a pandemic on March 11, 2020. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)[3]. This has resulted in a substantial change in the international social interactions. There has been a strong emphasis by the WHO on hand hygiene, face protection and avoidance of touching face, mouth and eyes[4] to contain the spread of this novel virus.

Contact lens-related microbial keratitis is the infection of the cornea of the eye where the lens rests. It is a complex multi-factorial disease[5]. Although the absolute rate of such infections is low among contact lens users, the risk may be enhanced in a hospital setting with an increased exposure to pathogenic organisms[6]. It can lead to serious complications including blindness and need for corneal transplants. The ocular surface of the eye is connected to the respiratory tract via the nasolacrimal duct. This would allow viruses to spread to the respiratory tract from the eye. Air-borne droplets can easily infect the exposed ocular surface[7]. Certain strains of coronaviruses can cause a variety of ocular complications in both animals[8] and humans[9]. The possibility that SARS-CoV-2 can also infect the ocular tissue cannot be ruled out. SARS-CoV-2 is thought to spread via respiratory droplet transmission[10] and presents with a myriad of clinical symptoms. The novel coronavirus has been detected in the tears and conjunctival epithelium of SARS-CoV-2 positive patients[11],[12]. A case has been reported where a COVID-19 patient has presented with conjunctivitis several hours before development of any respiratory symptoms[13]; however, the transmission rate from ocular tissue is suggested to be low[14]. The frequency of conjunctivitis in patients with COVID-19 is estimated to be <3 per cent[15]. Droplet transmission occurs from COVID-19 patients with respiratory symptoms (within 1 m distance); this increases the risk of HCWs of having their mucosa (nose and mouth) and conjunctiva exposed to potentially infective respiratory droplets in clinical settings[12],[16].

Risk for contact lens-related infections includes non-modifiable factors such as younger lens wearers, male sex, high refractive error, higher socio-economic status (unexplained, perhaps attributed to behaviour in lens wear) and previous ocular disease[17]. The modifiable risk factors are smoking, overnight use of lenses, use of water as solution to disinfect lenses, poor lens and hand hygiene, poor replacement schedule of lenses and lens cases and use of multiple day lenses compared to daily replaceable lenses[1] as these cause increased bioburden production over lenses. These risk factors remain valid for HCWs working during the COVID-19 pandemic.

Currently, available advice for the general public is conflicting as the Centers for Disease Control and Prevention (CDC) claims “no evidence to suggest contact lens wearers are more at risk for acquiring COVID-19 than eyeglass wearers”. It also claims that “hydrogen peroxide-based systems for cleaning, disinfecting, and storing contact lenses should be effective against the virus that causes COVID-19”[18]. While the American Academy of Ophthalmologists advises to switch to eyeglasses as people who wear lenses touch their face more due to increased irritation with lenses[19]. Current data are equivocal for contemporary lens solutions containing hydrogen peroxide to completely disinfect viruses[20],[21]. There is no study yet done to look at the current contact lens solutions and SARS-CoV-2 disinfection. As hands remain a vector for spreading the contracting microbes through contact lenses[22], the significance of hand hygiene cannot be stressed more as it has been recommended by both the CDC and the WHO. Hand hygiene should also be followed before application and removal of contact lenses. This advice can be followed to reduce the risk of contracting the virus. Contact lenses should be immediately removed and discarded if the eye gets infected.

Nosocomial spread of SARS-CoV-2 has been a major concern for both patients and HCWs[23]. In the increasing layers of personal protective equipment (PPE), contact lenses may be a liability as it requires extra care before and after use. Although the rates of transmission are low, the current solutions do not guarantee full disinfection. A risk all HCWs face in clinical environment is increased exposure to pathogens compared to the general public; even though the rate of contact lens-associated complications is low, seeking medical attention during the time of a global lockdown can be a potential issue. It has been postulated that there may be an increase of ocular surface infections in HCWs wearing contact lenses as the novel virus is transmitted via aerosol droplets and contamination of finger tips while applying and removing lenses. It is acknowledged that eyeglasses are a more suitable alternative to contact lenses, but that does not mean that it will protect against SARS-CoV-2. Eyeglasses are advised in busy clinical environments as these are easier to clean with soap and water and dried with a paper towel, unlike lenses which may need to be replaced or thoroughly disinfected. Wearing and removing eyeglasses may inadvertently result in touching one's face; however, contact lenses cause dry eyes in up to 40 per cent of wearers, leading to discomfort and more frequently touching one's eyes[24]. Despite this, certain advantages of contact lenses remain such as a safe way of correcting vision problems, especially in corneal dystrophies[25], and it may be more comfortable when worn with PPE than eyeglasses for HCWs. If HCWs still want to wear contact lenses, it is advised to wear daily disposable lenses[26] to minimize any contaminants in lens storage systems and to practice fastidious hand hygiene techniques.

Finally, further research is required to investigate the transmission and infectivity of SARS-CoV-2 through ocular tissue and secretions, to ascertain the interaction of lens material with the virus and to determine which lens solution components will fully disinfect this new virus.

Conflicts of Interest: None.



 
   References Top

1.
Steele KR, Szczotka-Flynn L. Epidemiology of contact lens-induced infiltrates: An updated review. Clin Exp Optom 2017; 100 : 473-81.  Back to cited text no. 1
    
2.
Rah MJ, Walline JJ, Jones-Jordan LA, Sinnott LT, Jackson JM, Manny RE, et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci 2010; 87 : 560-6.  Back to cited text no. 2
    
3.
Enserink M. Update: 'A bit chaotic.' Christening of new coronavirus and its disease name create confusion. Available from: https://www.sciencemag.org/news/2020/02/bit-chaotic-christening-new-coronavirus-and-its-disease-name-create-confusion, accessed on April 24, 2020.  Back to cited text no. 3
    
4.
World Health Organization. Coronavirus (COVID -19) advice for the public. WHO; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public, accessed on May 13, 2020.  Back to cited text no. 4
    
5.
Evans DJ, Fleiszig SM. Microbial keratitis: Could contact lens material affect disease pathogenesis? Eye Contact Lens 2013; 39 : 73-8.  Back to cited text no. 5
    
6.
Hay J, Seal DV. Contact lens wear by hospital health care staff: Is there cause for concern? J Hosp Infect 1995; 30 : 275-81.  Back to cited text no. 6
    
7.
Olofsson S, Kumlin U, Dimock K, Arnberg N. Avian influenza and sialic acid receptors: More than meets the eye? Lancet Infect Dis 2005; 5 : 184-8.  Back to cited text no. 7
    
8.
Seah I, Agrawal R. Can the coronavirus disease 2019 (COVID-19) affect the eyes? A review of coronaviruses and ocular implications in humans and animals. Ocul Immunol Inflamm 2020; 28 : 391-5.  Back to cited text no. 8
    
9.
Seah I, Su X, Lingam G. Revisiting the dangers of the coronavirus in the ophthalmology practice. Eye(Lond) 2020; 1-3.  Back to cited text no. 9
    
10.
Zeri F, Naroo SA. Contact lens practice in the time of COVID-19. Cont Lens Anterior Eye 2020; S1367-0484(20)30050-3.  Back to cited text no. 10
    
11.
Hui KP, Cheung MC, Perera RA, Ng KC, Bui CH, Ho JC, et al. Tropism, replication competence, and innate immune responses of the coronavirus SARS-CoV-2 in human respiratory tract and conjunctiva: An analysis in ex vivo and in vitro cultures. Lancet Respir Med 2020; S2213-2600(20)30193-4.   Back to cited text no. 11
    
12.
Xia J, Jianping MM, Mengyun T, Mm L, Shen Y. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020; 10.1002/jmv.25725.  Back to cited text no. 12
    
13.
Daruich A, Martin D, Bremond-Gignac D. Unilateral conjunctivitis as first presentation of Coronavirus Disease 2019 (COVID-19): A telemedicine diagnosis. J Fr Ophtalmol 2020. pii: S0181-5512(20)30147-9.  Back to cited text no. 13
    
14.
Seah IYJ, Anderson DE, Kang AE, Wang L, Rao P, Young BE, et al. Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients. Ophthalmology 2020. doi: 10.1016/j.ophtha.2020.03.026.  Back to cited text no. 14
    
15.
Guan W, Ni Z, Hu Y, Liang WH, Ou CQ, He JX,et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 : 1708-20.  Back to cited text no. 15
    
16.
World Health Organization. Modes of transmission of virus causing COVID-19: Implications for IPC precaution recommendations. WHO; 2020. Available from: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations, accessed on May 13, 2020.  Back to cited text no. 16
    
17.
Stapleton F, Edwards K, Keay L, Naduvilath T, Dart JK, Brian G, et al. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology 2012; 119 : 1516-21.  Back to cited text no. 17
    
18.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19): Frequently asked questions. Available from: https://www.cdc.gov/coronavirus/2019-ncov/faq.html, accessed on May 13, 2020.  Back to cited text no. 18
    
19.
American Academy of Ophthalmology. Eye care during the coronavirus pandemic. Available from: https://www.aao.org/eye-health/tips-prevention/coronavirus-covid19-eye-infection-pinkeye, accessed on May 13, 2020.  Back to cited text no. 19
    
20.
Heaselgrave W, Lonnen J, Kilvington S, Santodomingo-Rubido J, Mori O. The disinfection efficacy of MeniCare soft multipurpose solution against acanthamoeba and viruses using stand-alone biocidal and regimen testing. Eye Contact Lens 2010; 36 : 90-5.  Back to cited text no. 20
    
21.
Kowalski RP, Sundar-Raj CV, Romanowski EG, Gordon YJ. The disinfection of contact lenses contaminated with adenovirus. Am J Ophthalmol 2001; 132 : 777-9.  Back to cited text no. 21
    
22.
Fonn D, Jones L. Hand hygiene is linked to microbial keratitis and corneal inflammatory events. Cont Lens Anterior Eye 2019; 42 : 132-5.  Back to cited text no. 22
    
23.
Arabi YM, Murthy S, Webb S. COVID-19: A novel coronavirus and a novel challenge for critical care. Intensive Care Med 2020; 46 : 833-6.  Back to cited text no. 23
    
24.
Markoulli M, Kolanu S. Contact lens wear and dry eyes: Challenges and solutions. Clin Optom (Auckl) 2017; 9 : 41-8.  Back to cited text no. 24
    
25.
Rubinstein MP, Sud S. The use of hybrid lenses in management of the irregular cornea. Cont Lens Anterior Eye 1999; 22 : 87-90.  Back to cited text no. 25
    
26.
Chalmers RL, Keay L, McNally J, Kern J. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci 2012; 89 : 316-25.  Back to cited text no. 26
    




 

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