One of the questions I get asked a lot is “where is the evidence that wearing eye protection reduces the risk of exposure to SARS-CoV-2, because it’s really annoying to wear and creates other risks related to reduced vision”. A new systematic review examines the effect of eye protection on reducing healthcare worker exposure to SARS-CoV-2. The short answer is that there is enough evidence to convince me that eye protection should be part of our SARS-CoV-2 PPE ensemble.

The review identified only a small number of articles (5 in total), that examined the role of any form of eye protection in reducing laboratory-confirmed SARS-CoV-2 infection in healthcare staff. The study designs were far from optimal (three before-after studies, a retrospective cohort study, and a case-control study). Four of the studies found a protective effect of eye protection and one did not, with an overall relative risk reduction ranging from somewhere between 40% and 96%. Perhaps the most convincing single study identified in this review is a retrospective cohort study, examining 345 healthcare workers who were exposed to SARS-CoV-2 in the workplace. Healthcare workers who didn’t have eye protection during the exposure were 10x more likely to test positive for SARS-CoV-2 during their 14 day quarantine period than those who did.

The review includes a mixed bag of study designs and quality, so much so that a meta-analysis wasn’t possible. Also, any form of eye protection was part of the inclusion criteria, so it doesn’t help us with the goggles vs. safety specs vs. visor conundrum. Even more fundamentally, the inclusion criteria were not specific about the context in which eye protection was worn. Most would agree to wearing eye protection for a patient with confirmed SARS-CoV-2 infection in the early stage of symptomatic disease. But things get murkier when it comes to different scenarios (e.g. exposure to patients who do not have known SARS-CoV-2 infection – with or without blood or body fluid exposure risk). Finally, the inclusion criteria did not specify whether or not surgical (or other) masks were required. Therefore, part of the story here could be confounded by differences in face mask wearing.

Whilst the evidence is imperfect, I am convinced that wearing eye protection during patient contact in a healthcare setting during a pandemic makes sense especially when blood or body fluid is anticipated. Another recent review came to the same conclusion: that eye protection reduces the risk of SARS-CoV-2 (and MERS and SARS-CoV-1) infection in healthcare workers. I appreciate there are other risks to balance (not least visual impairment related to eye protection during PPE), but this review provides solid evidence that we must protect our eyes to fully protect ourselves from exposure to SARS-CoV-2 during patient care.