Sightsavers Reports

Personal protective equipment (PPE) for trachoma graders and trichiasis surgeons in the context of COVID-19

Status: Recently completed

Main Objectives

The objectives of the study are split across three phases:

Phase 1: Selection of personal protective equipment (PPE) configurations for further research

Phase 2: Classroom testing of selected PPE configurations to determine the potential impact on clarity of vision

Phase 3: Field testing of selected PPE configurations to assess the hypothesis that the face shield configuration is not associated with any problems of acceptance by the wearer during large scale surveys or during trichiasis surgery


This research responds to questions raised about the integration and interface of COVID-19 PPE items with ocular loupes (required to correctly grade trachoma during surveys and see during trichiasis surgery) and potential impact on routine trachoma grading and trichiasis surgery.

In phase 1, four possible PPE configurations were assessed by Tropical Data master graders and HEAD START master trainers. HEAD START is a training mannequin for trichiasis surgeries.

Two configurations were shortlisted for phases 2 and 3: Option 1: “Loupes worn through rectangular cut out and mounted on face shield” and Option 2: “Loupes worn in front and mounted on face shield mask”.

In phase 2, the potential impact of the selected configurations on clarity of vision was assessed by i) graders while conducting trachoma grading of images on a mobile phone; ii) surgeons conducting surgery on HEAD START surgical simulation devices.

Phase 3 assessed the following ‘key determinants’ of acceptance during routine programme use: operational performance, comfort and wearability, decontamination and reuse. This is important as trachoma survey graders mostly perform their roles outside, often in hot and/or humid conditions, while trichiasis surgeons conduct surgeries in rooms with natural ventilation rather than air conditioning and additionally, may be hot and/or humid.

Key findings

The two face shield configurations shortlisted for this research were shown to have minimal impact on trachoma grading and trichiasis surgery, but one rated better than the other in terms of comfort and ease of use.

Added value of the study

As a result of this study, the scientific community now knows that certain face shield configurations offer good visibility and comfort while maintaining accuracy in trachoma grading and surgical skills.

Policy and practice implementation

The study’s findings can inform guidelines and policies regarding the use of PPE in ophthalmic health care settings and contribute to the development of standardised protocols for trachoma elimination programmes worldwide. The study provides evidence that the use of face shields can be integrated into trachoma survey grading and trichiasis surgery protocols.


Funding for the study was provided by Tropical Data and the Accelerate programme. Tropical Data funding is provided by the International Trachoma Initiative, Sightsavers and RTI International through the United States Agency for International Development Act to End NTDs | East programme. Accelerate is funded by a consortium of donors including the Bill and Melinda Gates Foundation, CIFF, ELMA and Virgin.

Main Contact

Philip Downs
Technical director, NTDs
[email protected]


RTI International
Tropical Data



Nov 2020 – June 2022

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