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Purpose of review The use of nonpharmaceutical interventions can prevent viral spread in COVID-19 pandemic and PPE forms a crucial part of this strategy. However, there are discrepancies in existing guidelines and a lack of consensus among ophthalmic communities. This review aims to identify general consensus and provides recommendation of PPE for most common ophthalmological scenarios. With a global shortage of PPE, extended use and reuse strategies are also discussed. Recent findings In this review, guidelines and resources were selected, based on a three-tier process. The first-tier resources were from international infection control organizations. The second-tier resources were from ophthalmological professional associations and colleges. The third-tier resources involved a PubMed search using the keywords 'COVID-19; coronavirus; personal protective equipment' performed on 1 May 2020. Non-English guidelines and literatures were excluded. Summary On the basis of our methodology, we included a total of 30 documents, including 5 resources from tier 1, 14 resources from tier 2 and 15 from tier 3. Different levels of protection are necessary. Whenever performing an aerosol generating procedure, maximum protection should be ensured, this includes FFP3 respirator, fluid resistant gown, goggles or face-shield and disposable gloves. Similar protection should be used for handling COVID-19-positive/suspected case but the use of FFP2 respirator is acceptable. During routine outpatient clinic in cases of negative triage, it is recommended to use ASTM III surgical mask, plastic apron, disposable gloves and eye protection with goggles or face-shield. Lastly, patients should be encouraged to wear surgical masks whenever possible.

The material chosen can be a consensus among ophthalmologists locally Our experience is that the film should ideally be transparent to allow the examiner and the patient to see each other, and firm enough The study found that the spectrum of suitable material ranges from those that are firmer and stiffer, e g acrylic, to softer and more flexible, e g document folders and binding covers made of polyvinyl chloride (PVC) or polypropylene Firm plastic is ideal as it minimises the chance of the film springing back and forth, the movement which can be easily caused by the examiner's hand accidentally touching the film during examination However, one should note that thicker plastic may not be able to fit and it is not possible to cut safely with office tools Sticking a few pieces of thinner films together by thermal lamination is therefore an option The study also suggested using X-ray or MRI photographic film One may also expose the film to achieve transparency The Centres for Disease Control and Prevention (CDC) guidelines for disinfecting face shields were observed as slit lamp shields serve a similar role Along with slit lamps and table surfaces, they were cleaned with wipes containing 70% alcohol and allowed to air dry after each clinic session

Objective To investigate the ocular-hypertensive response to different dosages of topical dexamethasone eye drops in Chinese children. Design Prospective, randomized clinical trial. Participants Thirty-one consecutive children undergoing bilateral strabismus surgery. Intervention Topical dexamethasone (0.1%) was administered to children undergoing bilateral strabismus surgery. They were all less than 10 years of age. One eye was randomized to receive a regimen of four times daily, and another received a twice daily regimen. Intraocular pressure (IOP) was serially measured in the postoperative period for 4 weeks or more. Topical steroids were discontinued if IOP was 30 mmHg or more. Main outcome measures Intraocular pressure was measured on the day before the surgery, on postoperative days 1, 3, 5, 8, 12, 15, 22, 29, and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase, and time to reach an IOP more than 20 mmHg in the two study groups were analyzed. Results A total of 31 patients (20 male, 11 female) were examined. The mean age was 5.8 ± 2.0 years (range, 2–10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexamethasone treatment, both groups showed a significant rise in peak IOP compared with preoperative values (twice daily, 25.2 ± 6.8 mmHg vs. 14.3 ± 2.4 mmHg, P P P P P Conclusions In children treated with topical dexamethasone, ocular hypertension occurs in a dose-dependent manner. Children in the four times daily group had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and it would be desirable to monitor the IOP twice weekly when it is administered to children.

Purpose To compare the retinal nerve fiber layer measurements of attacked eyes with their fellow eyes after a single unilateral attack of acute primary angle closure (APAC). Methods Patients with a single episode of APAC in 1 eye, successfully treated with laser peripheral iridotomy, were recruited. Eyes with persistently raised intraocular pressure (IOP) after resolution of the acute attack were excluded. Scanning laser polarimetry was carried out at 6 months after remission of the acute attack. The various parameters between the attacked and the fellow eyes were compared using the Student t-test. Results Twenty-six patients (24 female and 2 male, mean age 66.9±8.1 years) were recruited. The duration of the APAC ranged from 5 to 98 hours (mean, 36.3 hours). The mean presenting IOP during the acute attack was 62.0±9.4 mm Hg. Only the mean inferior ratio and the ellipse modulation showed a statistically significant difference between the attacked and the fellow eyes among the 12 standard scanning laser polarimetry measurement parameters. Conclusion No severe retinal nerve fiber layer damage was documented in eyes that suffered a single episode of APAC with duration of attack up to 48 hours. With duration of attack longer than 48 hours, retinal nerve fiber layer damage was detected.

A 9-year-old girl presented with sudden loss of consciousness and CT scan of the brain showed right thalamic hemorrhage with ventricular extension (figure 1). Carotid and vertebral angiographic study revealed a …