outbreak has reached a critical state, and >200 countries worldwide have been affected. Iran was among the first countries that encountered the virus at a nationwide threat level. 1 The pandemic has imposed numerous burdens on society and the healthcare system.Medical specialties involve various examinations that may put patients and practitioners at risk of infection. Ophthalmic instruments may act as medium for viral transmission and ophthalmic healthcare facilities pose a risk of cross infection. 2,3 A recent review suggested that as coronaviruses are able to develop a wide range of ocular manifestations; thus, ophthalmologists should be cautious to prevent possible transmission through ocular tissue. 4 Cases of conjunctivitis have been reported in 6 In one report, 2 patients tested positive for SARS-CoV-2 using reverse-transcription polymerase chain reaction (rRT-PCR) assay of conjunctival secretions. 5 Moreover, the nasolacrimal duct may act as a pathway to transfer the virus from the eye to the nasopharynx. 7 Here, we address the prevention strategies employed against COVID-19 according to assessments of infection control experts and ophthalmologists, in Amiralmomenin Hospital a tertiary referral eye hospital in Guilan, Iran. To the best of our knowledge, this is the second report to describe the actions employed in an ophthalmology hospital setting. 8 At our institution preventive measures were applied in 3 main aspects outlined below. Patient management and screeningThe appointments of patients needing ophthalmic examinations (including those who had undergone corneal graft, cataract and vitreoretinal surgeries) were rearranged and other nonurgent appointments were deferred. Patients with a medical history of immune-suppression were appointed to be examined on a specific day. All elective ophthalmic surgeries and procedures were postponed, and patients were notified in advance; however, urgent ocular operations continued as normal.The daily number of patient referrals to the ophthalmic emergency unit decreased at an average of 58% compared to the previous month's daily average. This decrease was due to the hospital's relational unit advising local residents to seek ophthalmic care only when essential.Patients referring to the emergency unit were screened at the point of entry. The ophthalmic complaint was evaluated at triage by an eye-care nurse, and nonemergent conditions were requested to return for examination after the outbreak resolved. If the patient was physically capable, the companion would be asked to wait outside. All patients were asked about any related symptoms and underwent temperature screening. According to WHO definitions, 9 suspected COVID-19 cases would be isolated and transferred to a COVID-19 referral center for further evaluation.A safe distance (1.5 m) was assured between patients who were required to sit in the waiting room. Effort was made to maintain minimum waiting and consultation time. To avoid redundant visits to the hospital, patients who were managed in an outpatient setti...
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