Eye protection in orthopaedic surgery. An in vitro study of various forms of eye protection and their effectiveness.
BACKGROUND
Conjunctival contamination from splashed debris during orthopaedic surgical procedures places surgeons at risk for communicable diseases such as human immunodeficiency virus (HIV) and hepatitis B and C. The purpose of this study was to compare the effectiveness of various types of protective eyewear in preventing conjunctival contamination.


METHODS
A simulation model was constructed with use of a mannequin head in a typical position of a surgeon's head during an operation. The head was placed at an appropriate distance from the surgical field, and a femoral osteotomy was performed on a cadaver thigh. Six experimental groups were tested to determine the ability of various types of eye protection to prevent contamination of the conjunctiva: (1) modern prescription glasses, (2) standard surgical telescopic loupes, (3) hard plastic contoured glasses, (4) disposable plastic glasses, (5) a combination facemask and eye shield, and (6) no protection (control). Thirty femoral osteotomies were performed, and contamination of both the protective devices and the simulated conjunctival surfaces were recorded.


RESULTS
None of the tested devices were completely effective. The modern prescription glasses and the controls both were associated with conjunctival contamination rates of 83%. The other eye protective devices were associated with significantly lower rates of overall contamination, with a rate of 50% for the loupes, 30% for the facemask and eye shield, 17% for the hard plastic glasses, and 3% for the disposable plastic glasses.


CONCLUSIONS
Modern prescription glasses provided no benefit over the control in our experimental model; therefore, we do not recommend that they be used as the sole eye protection, especially during surgical procedures in which there is a high rate of debris expulsion from the wound. Readily available and disposable plastic glasses were associated with the lowest rate of conjunctival contamination (3%) and are an effective means with which to protect the orthopaedic surgeon from communicable diseases by conjunctival contamination.
Vanderbilt Orthopaedic Institute, Nashville, TN 37232-8774, USA. alfred.mansour@vanderbilt.edu
Alfred A
AA
Mansour
Jesse L
JL
Even
Sharon
S
Phillips
Jennifer L
JL
Halpern
D002102:Cadaver; D003228:Conjunctiva; D005135:Eye Protective Devices; D005269:Femur / Q000601:surgery; D006801:Humans; D008348:Manikins; D009985:Orthopedics; D010027:Osteotomy