Transmission in Health Care Setting

Thank you for your ongoing effort to educate people about HIV, I am glad to see you made a trip down to our neck of the woods (Africa). I am sure you saw the dynamics of "our" disease are quite different to that of the States.

I live in an area where HIV prevalence is chronic, in the order of 12-15% among adults. I recently had to get my eyes checked by an ophthamologist, I was not particulary happy with the way he conducted things and i am wondering if such a practice could present a possible exposure to HIV. There were a number of patients having the same procedure (slit lamp test). The procedure requires the ophthamologist to place a lens on your eye, often rubbing and coming into direct contact with your eyeball and other mucous membranes surrounding the eye.

I am really concerned because i was the last of about 6 people to have this procedure and when i had it, i did not see the ophthamologist wipe the lens off with alcohol etc.  About 2 weeks after i developed flu like symptoms, and this is only of concern because i have not come down with the "flu" for as long as i can remember.

So in summary, and possibly of use to others, what is the likelyhood of transmission of HIV with medical apparatus that has come directly into contact with an HIV positive persons eye and mucous membranes then into direct contact with your own eye and mucous membrane. Could sharing medical equipment, contact lenses, eye drops etc present a risk? Would testing be required?

[H. Hunter Handsfield, M.D.]

It is difficult for me to imagine that an ophthalmologist in an AIDS-endemic African country would fail to routinely use common disinfection procedures.  If not, I suppose there might be some small risk of HIV transmission by the exposure you describe.  But my recollection is that HIV is essentially absent from tears, and in any case the amount of actual secretion exchange would be small and the risk of HIV transmission undoubtedly very low to zero.  However, I'm definitely no expert on HIV transmission risk by this route.

Minor technical point:  I believe a slit-lamp examination per se does not involve direct contact of equipment with the cornea.  To my knowledge (and my personal experience as a patient), direct contact only occurs with glaucoma pressure testing, and requires a drop of anesthetic in the eye.  If you had only a slit-lamp exam without a glaucoma check, it might not be an issue at all.

Based on your description, I do not recommend testing in such a circumstance, but only you can decide whether your anxiety is such that you would be reassured by a negative test result.  Either way, I suggest you discuss this with the ophthalmologist.

Good luck--  HHH, MD