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R E V I E W Open Access
A comprehensive Chinese experience
against SARS-CoV-2 in ophthalmology
A-Yong Yu
*
, Ruixue Tu, Xu Shao, Anpeng Pan, Kaijing Zhou and Jinhai Huang
Abstract
The 2019 novel coronavirus disease (COVID-19) has now swept through the continents and poses a global threat to
public health. Several investigations have been conducted to identify whether COVID-19 can be transmitted
through the ocular route, and the conclusion is that it is a potential route but remains uncertain. Due to the face-
to-face communication with patients, frequent exposure to tears and ocular discharge, and the unavoidable use of
equipment which requires close proximity, ophthalmologists carry a high risk of contracting severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2). Based on 33 articles published by Chinese scholars, guidelines and clinical
practice experience in domestic hospitals, we have summarized the Chinese experience through the lens of
ophthalmology, hoping to make a contribution to protecting ophthalmologists and patients around the world.
Keywords: Coronavirus, SARS-CoV-2, COVID-19, Ophthalmology, Ocular transmission
Background
Since the first pneumonia patient was identified around
December 2019, in Wuhan, China, multiple human cases
of severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection have been reported. The 2019
novel coronavirus disease (COVID-19) has now swept
through the continents and poses a global threat to
public health. Up till 12th March 2020, at least 80,980
cases in China and 43,538 cases beyond China were
confirmed, covering 118 countries, areas or territories.
Many infections amongst medical staff have been re-
ported, of whom three ophthalmologists from Wuhan
Central Hospital died of COVID-19 due to occupational
exposure, and Dr. Guangfa Wang, a pneumonia expert,
was infected by SARS-CoV-2 through unprotected eye
exposure. These events raise an alarm on the route of
SARS-CoV-2 transmission. Faced with the possibility of
ocular transmission, ophthalmologists are very likely to
contract the infection. Drawing on the rich experience
during the previous SARS outbreak, the Chinese
government has promptly released various protection
measures for ophthalmology, and recommended protec-
tion for the eyes, as well as mouth and nose, when car-
ing for patients potentially infected with SARS-CoV-2.
The American Academy of Ophthalmology recently
published a similar recommendation for ophthalmolo-
gists from the Centers for Disease Control and Preven-
tion (CDC). Based on the latest published literatures,
guidelines and clinical practice experience in domestic
hospitals, we have summarized the Chinese experience
through the lens of ophthalmology, hoping to make a
contribution to protecting ophthalmologists and patients
around the world, and praying that the pandemic will be
contained as soon as possible.
Main text
Articles on SARS-CoV-2 for ophthalmology from Chinese
scholars
We searched MEDLINE, ScienceDirect, Embase, the
Cochrane Library, WanFang Database, VIP Database,
SinoMed, China National Knowledge Infrastructure
(CNKI), the CDC for COVID-19 website (https://www.
cdc.gov/coronavirus/2019-ncov/publications.htm),
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: yaybetter@hotmail.com
Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road,
Wenzhou 325000, Zhejiang, P. R. China
Yu et al. Eye and Vision (2020) 7:19
https://doi.org/10.1186/s40662-020-00187-2
Chinese Scientific Research Academic Exchange Plat-
form for COVID-19 (http://medjournals.cn/2019NCP/
index.do), and relevant references for papers related to
"ophthalmology and SARS-CoV-2/COVID-19"; pub-
lished till 12
th
March 2020. The search strategy was as
follows: (SARS-CoV-2 or 2019-nCov or COVID-19 or
NCP or coronavirus or "severe acute respiratory syn-
drome coronavirus 2" [Supplementary Concept] or
"COVID-19" [Supplementary Concept]) and (ocular or
eye or ophthalm* or ophthalmologist or tear or
conjunctiv* or "Conjunctivitis"[Mesh] or "Conjunctivitis,
Viral"[Mesh]).
We identified 33 articles in total published by Chinese
scholars directly relevant to ophthalmology and SARS-
CoV-2/COVID-19. Twenty-seven articles are published
in Chinese journals, most articles are reviews, almost all
regarding ophthalmic precautions and ocular surface
transmission of SARS-CoV-2 infection (Table 1).
Transmission of SARS-CoV-2
For ophthalmologists, comprehensive information is
needed to understand SARS-CoV-2 feature and epidemi-
ology of the outbreak. Coronaviruses are big, enveloped,
single, plus-stranded RNA viruses [34]. Seven corona-
virus species are known to cause diseases in humans,
among which “severe acute respiratory syndrome cor-
onavirus”(SARS-CoV), “Middle East respiratory syn-
drome coronavirus”(MERS-CoV), and SARS-CoV-2
drew great attention. SARS-CoV, MERS-CoV and SARS-
CoV-2 all belong to the β-CoV family and can cause
fatal pneumonia. MERS-CoV carries the highest fatality
rate of 34.5% [35], followed by SARS-CoV (9.6%) [36],
then SARS-CoV-2 (3.70%, following data till 12th March
2020), which has a lower disease severity but higher
transmission efficiency.
SARS-CoV-2 has been sequenced and was shown to
be 75–80% identical to SARS-CoV and 40% identical to
MERS-CoV [36]. SARS-CoV-2 shares the same host re-
ceptor with SARS-CoV, the human angiotensin-
converting enzyme 2 (ACE2) receptor, suggesting a simi-
lar transmission route. The person-to-person transmis-
sion of SARS-CoV-2 can occur through respiratory
droplet transmission and contact transmission. Airborne
aerosol and the fecal-oral transmission route [37] remain
to be further confirmed.
Theoretically, transmission through the ocular route is
likely for SARS-CoV-2. First, its host receptor ACE2 has
been identified on the ocular surface [38,39]. Second,
the ocular surface is an open microenvironment.
Through the nasolacrimal duct, the virus may transport
to the inferior meatus of the nose. Third, the ocular mu-
cosal immune system is associated with lymphoid tissue
in the nasolacrimal duct and nasal cavity [40].
There have been some studies reporting the presence
of SARS-CoV or MERS-CoV in tears or conjunctival sac
[41,42], while negative results in all of included patients
were also reported [43]. Several investigations have been
conducted to identify whether COVID-19 can be trans-
mitted through the ocular route. Shen and colleagues [3]
performed a prospective case series study in 30 COVID-
19 patients, finding SARS-CoV-2 in two conjunctival
swabs of one patient. Another study by Chen et al. [1]
demonstrated that out of 67 patients enrolled, SARS-
CoV-2 can be detected in the conjunctival sac of three
COVID-19 patients without ocular symptoms. Sun et al.
found [2] that among 72 patients confirmed by labora-
tory diagnosis with SARS-CoV-2 RT-PCR assay, SARS-
CoV-2 RNA fragments were found in ocular discharges
belonging to one patient. The above studies confirmed
that SARS-CoV-2 can exist in tears or the conjunctival
sac, but the infection of SARS-CoV-2 through the eyes
remains uncertain.
The negative results in the ocular surface may be in-
fluenced by viral concentration, sampling time lag, and
diagnostic method. The time of exposure to SARS-CoV-
2 infected patients is critical because of the higher viral
load at the early stage of infection. Improvements in the
sensitivity of molecular diagnostic methods are needed
in the future. More well-designed trials with large
sample sizes are required to ascertain whether the ocular
route is indeed a mode of transmission.
Precautions for SARS-CoV-2
Due to face-to-face communication with patients, fre-
quent exposure to tears and ocular discharge, and the
unavoidable use of equipment such as slit lamp, tonom-
eter, laser etc., ophthalmologists could carry higher risks
of contracting a SARS-CoV-2 infection. Ophthalmolo-
gists are recommended to take measures for mouth,
nose and eyes protection when caring for patients poten-
tially infected with SARS-CoV-2. The following recom-
mendations on ophthalmic practice are based on the
Guidelines for the Prevention and Control of Novel Cor-
onavirus Pneumonia in Medicine, the Guideline for the
Use of Medical Protective Equipment in the Prevention
and Control of Novel Coronavirus Pneumonia, the list
of published journal articles listed in Table 1and clinical
experience in domestic hospitals, as well as previous do-
mestic SARS experiences and other departments such as
the department of dentistry [44,45].
Outpatient management
Before coming to hospital
a) Control number of visiting patients
Yu et al. Eye and Vision (2020) 7:19 Page 2 of 9
Table 1 A summary of published articles by Chinese scholars directly relevant to ophthalmology and SARS-CoV-2/COVID-19
Study type Language N Date
(yyyy.mm.dd)
City Key Point
[1] Retrospective
cohort study
English 67 2020.02.11 Wuhan SARS-CoV-2 can be detected in the conjunctival sac of patients with COVID-19.
Through clinical analysis, viral transmission via the conjunctival route was not
supported by the data. Good clinical protection can effectively cut off the trans-
mission path.
[2] Cross-
sectional study
English 102 2020.02.26 Wuhan The nosocomial infection of SARS-CoV-2 through the eyes after occupational
exposure is a potential route. Protective goggles should be worn by all health-
care workers.
[3] Prospective
case series study
English 30 2020.02.26 Hangzhou SARS-CoV-2 may be detected in the tears and conjunctival secretions of COVID-
19 patients with conjunctivitis.
[4] Editorial English –2020.03.03 Hong Kong As the novel corona-virus infection is still on the upward trend, it is of para-
mount importance to remain vigilant and start taking necessary measures to
prevent its transmission.
[5] Editorial English –2020.02.13 Beijing, Hong
Kong,
Guangzhou
Ophthalmologists should take particular care when examining patients,
research studying whether COVID-19 can be found in tears and conjunctival
scrapings would be valuable and inform ongoing disease-prevention strategies.
[6] Letter English –2020.02.22 Changchun SARS-CoV-2 transmission through the ocular surface must not be ignored.
[7] Review Chinese –2020.02.22 Beijing A COVID-19 patient with ocular syndrome was reported and treated combined
with traditional Chinese medicine (TCM). The article discussed COVID-19 from
the perspective of TCM.
[8] Review Chinese –2020.02.23 Beijing Research of beta coronavirus receptors on ocular surfaces found two host
receptors, ACE2 and DPP4. Their expression in the cells of ocular surface may
be an access route of corona virus in eye, which provides clues to elucidating
the pathogenesis of corona virus in the eyeballs.
[9] Review Chinese –2020.02.13 Wenzhou This article preliminarily reviews several different aspects, including the
characteristics of SARS-CoV-2, the anatomical connection between ocular sur-
face and respiratory tract, previous work on the link between respiratory virus
and ocular complication, and the data of ACE2 receptor expression and mo-
lecular detection of SARS virus in tear. Based on these reviews, intervention
measures are advised for ophthalmic practitioner, whilst suggestions are indi-
cated for further clinical and basic investigations in the future.
[10] Review Chinese –2020.02.04 Wuhan It is extremely important to disinfect ophthalmic examination instruments and
protect ophthalmic medical care during the epidemic period to reduce cross-
infection in clinical practice. Some suggestions against SARS-CoV-2 infection
were offered in this article.
[11] Review Chinese –2020.02.12 Multi-center Ophthalmic experts, from Society of Public Health Ophthalmology, Chinese
Preventive Medicine Association and Beijing Ophthalmological Society and
Youth Committee of Beijing Ophthalmological Society, provided suggestions
on eye protection during the novel coronavirus pneumonia epidemic.
[12] Review Chinese –2020.02.14 Guangzhou The delay of back-to-school time is an important measure to reduce cross in-
fection on campus, and to protect the health of children and teenagers during
the 2019 novel coronavirus outbreak. Meanwhile, remote teaching models has
led to a dramatic shift in eye-use habits of children and adolescents. The poten-
tial effects on adolescent visual health cannot be ignored.
[13] Review Chinese –2020.02.24 Beijing This paper provided general guidance about precautions in ophthalmic
practice in the prevention and control of the novel coronavirus pneumonia
epidemic.
[14] Review Chinese –2020.02.17 Beijing/
Shenzhen
Some suggestions of integrated Traditional Chinese and Western Medicine are
described to avoid the infection of ophthalmic medical practitioners and to
effectively deal with novel coronavirus conjunctivitis during the diagnosis and
treatment.
[15] Review Chinese –2020.02.06 Beijing This article briefly introduced the characteristics and identifications of SARS-
CoV-2 infection, and put forward suggestions and opinions from the aspects of
personal protection of ophthalmologists, control managements of ophthalmic
outpatient department and ward, cleaning and disinfection of ophthalmic equipment.
[16] Review Chinese –2020.02.24 Chongqing During the prevention and control period of the epidemic of COVID-19, strict
adherence to the prevention and control measures can effectively ensure the
smooth implementation of the operation and the perioperative safety of med-
ical staff and patients
Yu et al. Eye and Vision (2020) 7:19 Page 3 of 9
Table 1 A summary of published articles by Chinese scholars directly relevant to ophthalmology and SARS-CoV-2/COVID-19
(Continued)
Study type Language N Date
(yyyy.mm.dd)
City Key Point
[17] Case report Chinese 30 2020.02.21 Wuhan Three cases in 30 NCP patients with binocular conjunctivitis were found. Of
them, one case visited for conjunctivitis as a first symptom and then diagnosed
as NCP, and two cases visited for binocular conjunctivitis during the NCP onset.
Although positive viral nucleic acid were detected in the conjunctiva sacs of 2
of other 27 NCP patients by using swabs and RT-PCR technology, no conjunc-
tivitis occurred in these two patients.
[18] Review Chinese –2020.02.21 Wenzhou Systematic and standardized detection of viral nucleic acid and related blood
factors is a necessary, fast and feasible prevention and control method in
specialist ophthalmic institute during the COVID-19 epidemic.
[19] Review Chinese –2020.02.17 Beijing This paper indicated some suggestions about the management of clinical trials
during novel coronavirus pneumonia outbreak including the follow-up of sub-
jects, the treatment of epidemic serious adverse event (SAE) and the manage-
ment requirements of co-sponsors, as well as the requirements and
management principles for environment, subjects, examiners and inspection
equipment in the process of ophthalmic clinical trials.
[20] Case report Chinese 2 2020.03.03 Wuhan Several COVID-19 cases with conjunctivitis or conjunctivitis as the first symptom
have been observed in clinical work. This paper reports the diagnosis and treat-
ment of one COVID-19 patient with conjunctivitis as the first symptom and one
COVID-19 patient with conjunctivitis.
[21] Review Chinese –2020.02.27 Xi’an Understanding the mechanism and cell receptors of coronavirus transmission
through ocular surface and the transmission characteristics of homologous
coronavirus can provide some suggestions for appropriately ocular protection
and identify COVID-19 coexisting with ocular signs for ophthalmologists during
this epidemic disease.
[22] Review Chinese –2020.02.17 Qingdao Strengthening basic and clinical research on ocular infection caused by
coronavirus should be one of the important tasks for ophthalmologists in China.
[23] Review Chinese –2020.02.23 Shantou In the absence of clinical and experimental evidence of SARS-CoV-2 in ocular
infection, a retrospective literature analysis of viral pathogens that simultan-
eously trigger ocular lesions during the onset of epidemic diseases helps under-
stand the methods of ocular protection in the prevention and control of the
COVID-19.
[24] Cross-
sectional study
Chinese –2020.02.27 Wenzhou Aerosol can be produced by non-contact “air-puff”tonometer spraying, and it
fluctuates with the increase of spraying times, showing a cumulative effect. The
aerosol accumulation is higher in the hall with insufficient air circulation. And
more aerosol can be produced without gauze mask.
[25] Review Chinese –2020.03.04 Lanzhou A review of the literature on coronavirus, especially SARS-CoV, can provide ref-
erences for the prevention and control of SARS-CoV-2.
[26] Review Chinese –2020.02.20 Jinan During the SARS-CoV-2 outbreak, ophthalmologists should be alert to the po-
tential transmission of ophthalmology-related viruses.
[27] Review Chinese –2020.02.10 Shantou This article reviews the eye performance of various types of epidemic virus
infections and provides a reference for COVID-19 prevention and control.
[28] Case report Chinese 4 2020.02.13 Wuhan Four COVID-19 patients with conjunctivitis were mentioned in this article, and
all the patients were medical staff of the hospital. One patient was positive for
conjunctival sac virus nucleic acid test.
[29] Review Chinese –2020.02.14 Hangzhou According to the characteristics of previous ocular-respiratory infection viruses,
ocular surface transmission may possible through the following ways: (1) infec-
tion through the nasolacrimal duct system. (2) infection through contact with
eyes and nose. (3) the above two conditions exist simultaneously and cause infection.
[30] Review Chinese –2020.02.18 Wuhan This paper suggests the necessary medical protective measures for
ophthalmology outpatient and ward. For the patients who were asymptomatic
with the virus, there is currently a lack of effective screening methods,
ophthalmologists need to be vigilant at all times.
[31] Review Chinese –2020.02.18 Multi-center Experts from multiple hospitals discussed the prevention and control system of
medical staff in ophthalmic medical institutions during the epidemic of COVID-19.
[32] Review Chinese –2020.03.01 Wenzhou The authors proposed how to choose protective goggles correctly, and seven
methods of anti-fog in this article.
Yu et al. Eye and Vision (2020) 7:19 Page 4 of 9
Reducing outpatient visitors will be critical to decrease
cross-infection. Patients are asked to make an appoint-
ment before going to the hospital.
b) Make good use of online platforms
Onlineplatformssuchasthehospital’s official web-
site or WeChat should be well utilized. Online plat-
forms can provide notice for decreasing outpatient
visits and updates on COVID-19, help patients distin-
guish between urgent and non-urgent ocular diseases,
recommend safe and self-executing treatments for
common nonurgent ocular diseases, remind patients
to prepare correct personal protection before coming
to the hospital, advise patients with suspicious symp-
toms such as fever to first visit the screening center
before coming to the ophthalmic clinic, and give
targeted guidance for common chronic eye diseases
during this period.
c) Online ordering and delivery of prescribed
medication
Both hospital and patients can benefit from submitting
prescriptions online and having patient medication sent
to their doorsteps via non-contact delivery.
Entering the hospital
a) Reduce the number of accessible gateways into and
out of the hospital by closing unnecessary ones
Visitors will be funneled through these gateways to
allow for efficient manpower management.
b) Set up two checkpoints in hospital entrance and
treatment area entrance (Fig. 1)
Visitors should be screened through temperature
measurement and symptoms before entering the hospital
and treatment area.
The questionnaire includes questions about typical
clinical symptoms of COVID-19, travel history to Wu-
han city and other badly affected areas or countries,
contact history with confirmed or suspected COVID-19
patients within the past 14 days, etc. (Fig. 1).
c) Remind patients to properly put on the mask
Every patient should wear the mask at all times in the
hospital, if the self-prepared mask cannot sufficiently
protect the patient, the hospital shall provide a suitable
one.
d) Prepare a separate clinic for patients with
symptoms of infection
Setting up a special clinic for conjunctivitis is recom-
mended, and patients with conjunctivitis and suspicious
contact/travel history should be treated for COVID-19.
Patients with suspected conjunctivitis are advised to be
tested more than two times for SARS-CoV-2 RNA in
the conjunctival sac and tears.
Entering the clinic room
a) Practice social distancing in the registration and
waiting areas
Patients should stay at least 1.5 m apart from one
another when in registration and waiting area.
b) Limit the number of people in the room
Keeping 1 doctor and 1 patient in 1 room is required
except for visually impaired patients, patients with com-
munication/mobility difficulties or parents of small chil-
dren. The room should be well-ventilated. After each
patient’s consultation or treatment, the used instruments
such as slit lamp must be disinfected immediately.
c) Reduce outpatient examinations
Operation of many ophthalmic equipment requires
close proximity, reducing outpatient examinations helps
protect both doctors and patients.
Micro-aerosols can be generated when non-contact to-
nometry is used [46]. Air-puff ophthalmic equipment
like non-contact tonometry should be avoided if un-
necessary. It is advised to place the tonometer in a
Table 1 A summary of published articles by Chinese scholars directly relevant to ophthalmology and SARS-CoV-2/COVID-19
(Continued)
Study type Language N Date
(yyyy.mm.dd)
City Key Point
[33] Cross-
sectional study
Chinese –2020.03.08 Wenzhou The Remote Dedicated Doctor Platform of Ophthalmology (RDDPO) establishes
a channel for doctor-patient communication during the epidemic, which can
be considered as an important way to effectively address the needs of patients
for medical treatment.
Yu et al. Eye and Vision (2020) 7:19 Page 5 of 9
ventilated place, and that the measurement interval be-
tween patients should be extended. During the measure-
ment, patients should wear a face mask.
Direct ophthalmoscope examination is not recom-
mended, which can be replaced by slit light lens or fun-
dus photography. Protective shields (better transparent)
should be installed on slit lamps and any other equip-
ment used which needs close doctor-patient contact.
Both doctor and patient should refrain from bare face-
to-face speaking during any examination.
Inpatient management
Before coming to the ward
a) Control the number of scheduled surgeries
Non-emergency surgeries, such as elective cataract
operations and ophthalmic plastic surgery, should be
postponed. Emergency surgeries, such as endophthal-
mitis, eyeball rupture, macula-on rhegmatogenous
retinal detachment and intraocular foreign body, can
continue. Elective surgeries should still be appro-
priately reduced in areas where the infection is under
good control.
b) Improve preoperative infection screening of
inpatients
Preoperative CT examination, SARS-CoV-2 (RNA)
detection, and blood routine examination are recom-
mended. Testing of nasopharyngeal swab two or more
times is recommended in suspected cases with an ini-
tially negative result [36]. If CT examination is not avail-
able for specialized hospitals or primary hospitals (lack
of medical imaging department), or due to some limita-
tions with regards to special groups (such as pregnant
women), inspection of hematological indices including
C-reactive protein (CRP) and serum amyloid A (SAA)
are suggested as routine tests of preoperative screening
for ocular surgery patients.
The infection screening results need to be checked
and confirmed before surgery appointment. In general, a
patient with COVID-19 is not recommended to undergo
ocular surgeries unless urgent. The emergency surgeries
for a COVID-19 infected patient should be arranged in a
negative pressure operating room, with advance notice
given to the ward and operating room. If there is no
negative pressure operating room in the hospital,
COVID-19 patients should go to other qualified
hospitals.
Fig. 1 Patient screening chart
Yu et al. Eye and Vision (2020) 7:19 Page 6 of 9
Entering the ward a) Repeat temperature taking and
query with questionnaire
Repeated temperature taking and query with question-
naire ought to be done at the ward entrance. In addition,
daily temperature measurement must be a routine for all
patients. The patient’s temperature and necessary exami-
nations should not be ignored.
b) Check infection screening results of inpatients again
Infection screening results of inpatients should be
checked immediately after the patient enters the ward.
Repeated preoperative CT examination, SARS-CoV-2
(RNA) detection, and blood routine examination after
hospital admission are also recommended by some
experts.
c) Arrange a single room for every patient if possible
The necessary doctor-patient conversation can be con-
ducted in the patient’s room. One patient is not allowed
to have more than one attendant, and the attendant
should be the same. Both patient and the attendant
should wear the mask.
d) Reduce unnecessary inpatient examinations
e) Avoid operations under general anesthesia if
possible
Operations should preferably be done under local
anesthesia. The operating room should be left standing
for a sufficient time between each operation after ad-
equate disinfection measures. Operations for healthy
patients will be done in a positive pressure laminar flow
operating theater while for suspected or infected
patients, in a negative pressure laminar flow operating
theater.
Staff management
1) Offer relevant infection control training to the staff
The training content should include current knowledge
of COVID-19, precaution measures, hand disinfection
training, etc. Ophthalmologists should be able to identify
a suspected case of COVID-19. Typical clinical symptoms
of SARS-CoV-2 infection were onset of fever, generalized
weakness, myalgia and dry cough [36,47]. The clinical
manifestations of conjunctivitis in COVID-19 patients are
consistent with other viral conjunctivitis [6].
2) Report temperature and abnormal symptoms every
day
Temperature taking and query with questionnaire be-
fore entering the hospital also applies to staff. Staff are
advised to measure their own body temperatures twice
every day and promptly report any abnormal symptoms.
3) Increase personal protection
Caps, respiratory protection, gloves, gowns, eye protec-
tion, and face shields are used for personal protection.
Based on the possibility of the spread of SARS-CoV-2
infection, three-level protective measures for ophthalmic
professionals are as follows (Table 2).
Strict hand hygiene is required for every staff. It is ad-
visable to not use a pair of latex gloves for long periods
of time. Moreover, strict hand hygiene must be practiced
after taking off gloves.
4) Set up inspectors and inspection group
Inspectors and inspection group will check the imple-
mentation of protective measures for members in their
respective departments every day. Furthermore, they will
also examine the patients’self-protection.
Environmental management
1) Turn off the central air conditioning, enhance the
air ventilation
2) Disinfect rooms and instruments thoroughly
Rooms and instruments should be thoroughly dis-
infected according to local disinfection guidelines. The
elevator should be disinfected regularly. People should
avoid unnecessary contact with elevator buttons and
other objects when using the elevators.
Patient education
Patient education is crucial. It is vital to prevent nosoco-
mial cross-infections, and thus every patient needs to
pay attention to personal precautions.
Online platforms, the hospital’s official website or
WeChat public platform, for example, should be well
utilized before patients come to the hospital as men-
tioned above.
When patients are in the hospital, videos in the wait-
ing rooms and brochures are effective approaches to
teach patients updated knowledge regarding COVID-19
and personal hand hygiene, as well as remind them of
proper mask wearing, and practicing social distancing.
Follow-up after discharge is easy to overlook. Despite
rigorous preoperative screening, it is possible that pa-
tients in the incubation period or asymptomatic patients
may be admitted for surgery. Telephone follow-up,
Yu et al. Eye and Vision (2020) 7:19 Page 7 of 9
asking about their postoperative symptoms, is very im-
portant for us to prevent unexpected virus transmission.
Conclusions
The SARS-CoV-2 infection in China has been well con-
trolled thanks to the large collective effort. The National
Health Commission has reported that the peak of the
current infection in China has passed. However, a com-
ing nationwide resumption of work in China and devel-
oping epidemic in foreign countries are worrying; we
still need to take every precaution against COVID-19.
Since 2002, coronaviruses seem to impose a continu-
ous and enormous threat to human beings. Even as this
infection dies down, we should be vigilant of future out-
breaks. Ocular transmission of coronavirus remains un-
certain, and more well-designed trials with large sample
sizes are urgently needed.
Disclosure and sharing of knowledge are keys to con-
trolling the outbreak. Again, we sincerely hope the Chin-
ese experience against SARS-CoV-2 in ophthalmology
can, to some extent, contribute to protecting the lives of
ophthalmologists and patients worldwide.
Acknowledgements
Not applicable.
Authors’contributions
Design of the study (A.Y., R.T.); literature/data collection and analysis (R.T.,
A.P., A.Y.); writing the manuscript (R.T., A.Y., X.S.); critical revision of the
manuscript (A.Y., K.Z., J.H.); supervision (A.Y.). All authors read and approved
the final manuscript.
Funding
Supported by the Natural and Science Foundation of China (Grant No.
81570869), and Wenzhou Key Team of Scientific and Technological
Innovation (Grant No. C20170002).
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no conflict of interest.
Received: 15 March 2020 Accepted: 25 March 2020
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Table 2 Three-level protective measures of the ophthalmic professionals
Level of
protection
Protective measures Applicable object
Primary
protection
Cap, surgical mask, and working clothes (with/without gown) Indirect contact with patients, usher, non-operative inquiry and
ward rounds.
Secondary
protection
Cap, surgical mask/N95 mask, working clothes with gown,
protective goggles/face shield, and disposable gloves
Direct contact with patients such as slit lamp, gonioscopy,
ultrasound and other specialized examinations; puncture,
injection, outpatient laser and other professional operations.
Tertiary
protection
Cap, N95 mask, protective clothing with gown, protective goggles,
face shield, and two pairs of disposable gloves
Contact with blood, body fluids, secretions and other spillages;
specimen collection that may produce eye aerosols; internal eye
surgery etc.
The anesthesiologist should also adhere to this level of
protection during general anesthesia operations.
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