Ocular Disinfection Protocol for Ophthalmic Surgery
Perform preoperative ocular disinfection using povidone-iodine with 10% solution on periocular skin and 5% solution on the ocular surface (cornea, conjunctiva, and fornices), followed by thorough irrigation with sterile saline. 1, 2
Preoperative Preparation
Periocular Skin Disinfection
- Apply 10% povidone-iodine to the periocular region (lids, brow, and cheek) as this concentration significantly reduces endophthalmitis risk compared to 5% on skin 3
- Allow adequate contact time for bactericidal effect 2
Ocular Surface Disinfection
- Instill 5% povidone-iodine solution directly onto the ocular surface (cornea, conjunctiva, and palpebral fornices) 1, 2, 4
- This concentration reduces conjunctival bacterial flora from 66% to 30% positive cultures compared to saline alone 4
- Flush the eye thoroughly with sterile saline solution after application to remove residual povidone-iodine and prevent toxicity 2
Critical Timing Considerations
- Apply povidone-iodine immediately before surgery within the preoperative preparation 5
- For enhanced protection, consider 3-day preoperative course of broad-spectrum topical antibiotics (such as fluoroquinolones) followed by povidone-iodine application on the day of surgery 5
Alternative Dosing Strategy for Enhanced Sterility
For high-risk cases or prolonged procedures, consider repetitive application of dilute (0.25%) povidone-iodine every 30 seconds throughout surgery rather than single 5% application 6, 7
Rationale for Dilute Repetitive Dosing
- Dilute concentrations (0.05%-1.0%) kill bacteria more rapidly than conventional 5%-10% concentrations due to greater availability of free diatomic iodine 6
- Repetitive dilute application maintains transient ocular surface sterility throughout the procedure 7
- Lower toxicity profile compared to higher concentrations 6, 7
- Effective against multidrug-resistant bacteria, fungi, and novel pathogens without inducing resistance 7
Instrument and Equipment Sterilization
Ensure strict sterilization of all surgical instruments and improve disinfection methods to avoid residual disinfectant contamination 1
Key Points
- Carefully examine and clean the operative eye before disinfection 1
- Avoid residual disinfectant which can cause postoperative inflammation 1
- Minimize surgical duration and light exposure to reduce ocular surface stress 1
Common Pitfalls to Avoid
- Never use povidone-iodine for intraocular injection or irrigation - it is for external use only 2
- Do not use on patients with known iodine sensitivity 2
- Avoid inadequate flushing after povidone-iodine application, which increases toxicity risk 2
- Do not substitute with less effective alternatives like hypochlorous acid, which has significantly reduced efficacy against endophthalmitis isolates 7
- Avoid using 5% povidone-iodine on periocular skin when 10% is available, as this increases infection risk 3
Adjunctive Measures
- Consider periocular administration or intraocular injection of antibiotics and/or steroids immediately before the end of surgery 1
- Use viscosurgical devices during surgery to protect ocular tissues 1
- Minimize thermal energy from phacoemulsification devices 1
- Avoid large corneal incisions and aspirating speculums 1