• Written By:
    Comprehensive Ophthalmology

    The authors discuss the appropriate personal protective equipment (PPE) requirements for surgeons as well as the usage, availability and rationing of materials during the COVID-19 pandemic.

    Study design

    This systematic review included 95 studies identified using MEDLINE, EMBASE, & WHO-COVID-19 databases as well as newspaper and internet articles. All articles that reported the potential risks of transmission in surgery, types of PPE and specialty-specific risks and guidance were included.


    The World Health Organization (WHO) recommendations for PPE when interacting with patients with known or suspected COVID-19 include disposable aprons, gloves, fluid repellent, surgical masks and eye protection (googles or face shield). China produces the majority of PPE. Modeling estimates from the WHO revealed that health care professionals need approximately 89 million medical masks, 76 million gloves, 1.6 million goggles and 30 million gowns for COVID-19 response each month. The disruption to the worldwide supply chain has caused a lack of PPE for medical staff and has resulted in confusion about when PPE is necessary.

    For surgeons, sources of COVID-19 transmission during surgery include respiratory particles or droplets. In addition, plumes of smoke released during electrocautery could result in COVID-19 transmission; other viruses (HPV, HIV) have been found in plumes of smoke during electrocautery. Smoke evacuation methods should therefore be used during this current pandemic. In addition, certain subspecialties are at elevated risk for potential for exposure to higher viral loads from mucosal membranes; this includes plastic and reconstructive surgery of the head and neck as well as endoscopies. The British Association of Oral and Maxillofacial Surgeons recommends full PPE for all close face-to-face contact with patients during treatment and examinations. These recommendations can be extrapolated to oculofacial plastic surgery.


    Various types of articles were used and not all surgeons are publishing what PPE they are using. In addition, PPE recommendations are continually changing.

    Clinical significance

    China showed high infection rates among health care workers until the availability of PPE was sufficient. Understanding the limited supply of PPE, surgeons should not be treating patients with inadequate protection. Additionally, until there is a vaccine or proven treatment, surgeons should take precautions to reduce transmission.