Nurses in Paris developed eye problems while using eye protection to care for critically ill patients in COVID-19 intensive-care wards, according to a new report by French doctors.
The nurses were prescribed an eye ointment and their eyelids later healed, but healthcare workers should be aware of COVID-19 disinfection chemicals potentially causing such irritations, Drs. Bruno Megarbane and Ramin Tadayoni of Lariboisiere Hospital, in Paris, write in Occupational and Environmental Medicine.
“Three nurses complained about the onset of painless eyelid swelling and tearing almost at the same moment,” said Dr. Megarbane, head of the department of critical care.
“Nurses spent hours in the rooms where the patients were admitted and were mechanically ventilated while wearing masks, eye protection, long-sleeved disposable gowns, aprons, goggles and gloves,” he told Reuters Health by email.
Dr. Tadayoni, an ophthalmologist, confirmed that the nurses had inflamed nodules on the middle of their lower eyelids, as well as redness. He diagnosed them with chalazions, or cysts, and prescribed a topical antibiotic and anti-inflammatory eye ointment. The nurses also applied warm compresses to their eyes and massaged the lids to encourage healing.
The two doctors then wanted to understand what caused the cysts so they could improve working conditions while nurses helped COVID-19 patients. Although eye issues have developed in some people who contract the coronavirus, the symptoms usually develop during the middle phase of the illness and when patients have severe pneumonia, they note. The nurses tested negative and were advised to continue working.
Drs. Megarbane and Tadayoni then investigated the personal protective gear itself. Eye cysts tend to come from inflammation and obstruction of the sebaceous glands in eyelids or the tear ducts, so they believed the masks or glasses could be a problem if they directed the breath toward eyelids.
At the same time, the nurses wore sealed protective glasses that were disinfected for 15 minutes in an antiseptic often used in hospital and surgical settings.
Exposure to these chemicals can lead to skin irritation or breathing problems, and the authors conclude that the eye protection needed while caring for COVID-19 patients likely led to the eye infections.
“It appears that the conditions of disinfecting and rinsing the eye protections in small boxes at the bedside, as well as the duration of exposure to the disinfectant, could have been responsible,” Dr. Megarbane said.
At the hospital, staff changed the recommendations for rinsing and wearing the disinfected glasses. Since the change, no additional cases have occurred.
A month after the initial cluster, the three nurses’ eyelids had almost completely healed. The hospital’s ophthalmology department also looked back and recorded 10 additional cases of eye issues during March 2020, which were mostly among nurses working at the hospital.
“Working with COVID patients was a hard experience, and PPE complicated the working conditions,” Dr. Megarbane said. “My advice is to continue working safely and apply all the recently improve procedures for future COVID and non-COVID patients.”
Researchers are still studying how SARS-CoV-2, the virus that causes COVID-19, may affect the eyes. Doctors in several countries have published observations about pink eye, watery eyes and eye inflammation in some COVID-19 patients.
“More research has to be done to confirm its ability to infect ocular tissue,” said Dr. Rupesh Agrawal of the National Healthcare Group Eye Institute at Tan Tock Seng Hospital in Singapore. Dr. Agrawal, who wasn’t involved with the new article, wrote about COVID-19 and eye issues in March.
“This will not only help to guide infection-control measures but can provide insights on the feasibility of using ocular tissue or even tears as a medium of diagnosis,” he said. “Meanwhile, ophthalmologists and other healthcare workers should continue to err on the side of caution and continue to prevent the possible transmission of (novel coronavirus) through ocular tissue.”