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Infection via eye mucosa and PEP
May 27, 2009

Dear dr. Young

I am a health care provider, on ophthalmologist. During a vitrectomy (surgical procedure on the retina)i got splashed to my eyes with some droplets coming from the patients eye (during the procedure the operated eye volume is maintained by the infusion of saline solution and when you exchange intraocular instruments the incision ports remain open and may sprinkle due to the continuous infusion to the eye).

This fluid may have been containing with some blood as during the procedures some internal eye bleeding may occur.

I understand that overall risk in case of eye mucosa exposure has been estimated to 0.1%

Please tell me in case of infection by splash to the eye are we talking about major splash with higher volume of blood or even some small volume of somewhat diluted blood may pose significant risk?

I did not rinse my eyes as I did not want to stop the procedure, and I assumed the quantity was small and blood was diluted. How would you estimate my risk? Was PEP warranted?

I do hope you would consider my question to be answered.

Kind regards Marko

Response from Dr. Young

Hello Dr. Marko and thanks for your post.

Sorry to hear about your occupational exposure- these can be trying experiences.

I don't believe that there are any quantitative data on the risk of infection following ocular exposure.

It stands to reason (from extrapolation of the percutaneous injury literature) that your risk is probably on the low end of this spectrum, given that the volume of body fluid exposure was low, the blood was diluted and that there wasn't a occular injury (to you).

Nevertheless, I'd hesitate to tell you not to take PEP. While PEP isn't any fun, it can be reasonably well tolerated, and at least provides a measure of treatment that could reduce your risk of acquiring HIV. I'd hate to not suggest PEP only to have you seroconvert.

So, yeah, this is a hedged answer. But, if I were you I'd take the PEP.

Best of luck. Write back with follow up- I'm sure that readers will be interested.

BY



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