Eye Protection in Orthopaedic Surgery: An in Vitro Study of Various Forms of Eye Protection and Their Effectiveness

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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.

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