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Blood into eyes, PEP reccomended?
Sep 5, 2007

Dear dr. Young

Thank you for reading this mail. I am an eye doctor and have recently been performing a fluorescein angiography procedure on an assumable HIV positive patient from an another country ( he had CMV retinitis). Unfortunately I lost a track of him and I didn't find out the results on his HIV testing which I recommended. He was not aware of high probability that his eye condition could suggest the HIV infection so only after my suggestion he considered HIV testing, but never came back to share the results with me.

During the process of taking the intra venous needle out from his vein I believe a drop of his blood splashed me into my eye. Stupidly I didn't rinse my eye, but thought it was probably nothing serious since it was not a major splash to my face. But later I got very upset and now can not function normally on my job because of the incident. Unfortunately I come from a country in which there are no incident reports forms to fill out and where the post exposure prophylaxis is rarely available and where people would think I am crazy for being concerned of the incident.

I am aware of the blood to mucose membrane exposure overall risk of 0.1%, but this risk was calculated based on reports from people probably rinsing the mucose membranes after the incident which I didn't do.

While waiting for the 3 month window period to pass and to be tested, are you of an opinion that I should have been put on PEP since I didn't rinse my eyes, or do you think I still fall into overall risk category of 0.1%?

I thank you for considering my mail to be answered.

Kindest regards and many thanks

Anthony from southeastern Europe

Response from Dr. Young

Anthony, thanks for your post.

You've summed up the overall risk of mucous membrane exposures. Overall, it's quite low- it's hard to caclulate the effect of rinsing the eyes (or lack thereof).

With all PEP time since exposure is the most critical. We generally try to initiate PEP treatment within 48-72 hours after exposure. After that point, the benefit of PEP diminishes.

Given your known exposure (if you're still within the time window), I'd recommend starting PEP.

Hope this helps, and best of health to you. BY



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