Incidence of Infection Associated With Contact-Retinal Photography in the Neonatal Intensive Care Unit

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : Based on the Spaulding classification, a device that contacts a mucous membrane requires high-level disinfection (HLD). Retinal photography utilizing a camera that contacts the cornea is commonly used in the neonatal population. HLD of these camera lenses requires more processing time, staffing, and additional camera lenses. This study aimed to retrospectively review the incidence of eye infections in infants who underwent retinal photography before HLD was implemented to evaluate necessity of such protocols.

Methods : We performed a 10-year retrospective chart review (2014-2024) of 1,245 retinal photography encounters (utilizing the RetCam) at Corewell Health Helen DeVos Children’s Hospital Neonatal Intensive Care Unit (NICU) prior to our institution’s implementation of HLD for camera lenses. The primary outcome was incidence of conjunctivitis within 2 weeks post-retinal photography. Additionally, incidence of infection prior to and beyond 2 weeks post-imaging was investigated as a secondary outcome.

Results : Of 1,245 RetCam encounters, 12 cases of conjunctivitis occurred within 2 weeks after retinal photography, yielding an incidence rate of 0.96% (95% CI: 0.55%-1.68%). The mean time to diagnosis was 7.1±3.3 days. There were 15 cases of conjunctivitis (1.20%) after 2 weeks post-photography and 75 cases (6.02%) that occurred before photography. There were no reported cases of corneal infections. Additionally, the incidence of nasolacrimal duct obstruction was 4.8% in this cohort, a likely contributing factor in the diagnosis of infection.

Conclusions : Before implementation of HLD, the retinal camera lens was cleaned with alcohol disinfecting wipes per manufacturer guidelines. The incidence of conjunctivitis after retinal photography during this 10-year time frame was very low. In fact, the incidence of infection in the same population was higher prior to the retinal photography encounter, confirming unlikely correlation of retinal photography as etiology for infection. Nasolacrimal duct obstruction is common in newborns and most likely a risk factor for infection in this population. The HLD protocol requires more cost and resources, the feasibility of which can impact patient care. Based on this review of 10 years of data, HLD for retinal camera lenses may be unwarranted. Additional validation studies should be considered for potential revision of this cleaning protocol for ocular imaging.

Volume

67

Issue

7

First Page

5041

Last Page

5041

Comments

Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, May 3-7, 2026, Denver, CO

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