The Journal of Bone and Joint Surgery (American). 2009;91:1050-1054.
doi:10.2106/JBJS.H.00460
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Eye Protection in Orthopaedic Surgery

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

Alfred A. Mansour, III, MD1, Jesse L. Even, MD1, Sharon Phillips, MSPH2 and Jennifer L. Halpern, MD1

1 Vanderbilt Orthopaedic Institute, 1215 21st Avenue South, MEC, South Tower, Suite 4200, Nashville, TN 37232-8774. E-mail address for A.A. Mansour: alfred.mansour{at}vanderbilt.edu
2 Vanderbilt University Medical Center, 1161 21st Avenue South, S-2323 MCN, Nashville, TN 37232-2158

Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).

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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