Eliminating risk of endophthalmitis during intravitreal injections for patients wearing masks

Investigators from Tel Aviv, Israel, cautioned this week that patients who wear face masks during the administration of intravitreal injections could be at a higher risk for the development of endophthalmitis.

The investigators reached this conclusion based on the results of a prospective interventional study in which healthy volunteers wore three different surgical masks and the investigators monitored the air leaks around the eyes.

When a patent is wearing a mask during intravitreal injections, they could be at an increased risk of endophthalmitis because exhaled air is tunneled toward the eyes.

Amir Hadayer, MD, lead author of the study, described the surgical face masks as those with four tying strips, with elastic ear loops, and 2200 N95 tuberculosis particulate face masks.

During the study, the participants’ periocular area was evaluated to identify leakage of air during normal breating, speaking, and deep respirations.

The investigators used thermal cameras to identify the air leaks, including the FLIR A310 thermal camera (FLIR Systems Inc.) and the EyeCGas 2.0 (OPGAL) a “supersensitive” infrared camera.

Hadayer, who is with the Department of Ophthalmology at the Rabin Medical Center in Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, noted that the experiment was repeated 45 times for each of the cameras, 3 times with each of the 3 masks, on 5 volunteers, for a total of 90 trials.

The investigators reported their results in Retina.¹

“Air jets were detected originating from the superior edges of the masks radiating toward the eyes in 81% (73/90) of cases in total; 71% (32/45) with the FLIR camera and 91% (41/45) with the OPGAL camera. Air leaks were detected with all investigated mask types,” they noted.

The study concluded that patients wearing face masks during the administration of intravitreal injections may be at a higher risk of development of endophthalmitis.

The investigators advised that the fit of the mask be confirmed if one is worn during administration of the injections and suggested that the upper edges of the masks be taped using a medical adhesive tape.

Alternatively, they also suggested that an adhesive surgical drape could be positioned around the eyes into which the injections are being administered.

REFERENCES
1. Hadayer A, Xahavi A, Livny E, et al. Patients wearing face masks during intravitreal injections may be at a higher risk of endophthalmitis. Retina 2020;40:1651-6; doi: 10.1097/IAE.0000000000002919