Regulators in the US and elsewhere have increasingly cited clinics for not applying high-level disinfection to Goldmann tonometer tips, gonioscopy lenses, laser lenses and similar reusable devices that touch the ocular surface. A multisociety task force reviewed the evidence (Ophthalmology, 9 October 2026); its summary recommendations come from a policy statement approved by the American Academy of Ophthalmology board and endorsed by four subspecialty societies.
The task force found no published evidence that these devices transmit sight-threatening infection, or that high-level disinfection reduces transmission compared with lower-level methods. In its survey of more than 1,000 ophthalmologists, alcohol wiping was the commonest method for tonometer tips, and alcohol or soap and water for lenses; many who used chemical high-level disinfection reported ocular surface chemical toxicity and device damage. Reported transmission was very rare and mostly self-limiting adenoviral conjunctivitis. The authors argue the century-old Spaulding classification wrongly groups the ocular surface with heavily contaminated mucous membranes.
The recommendation is that high-level disinfection should not be required in routine care, and should be a discretionary step in higher-risk situations, such as after use on a patient with suspected infection.
- Use your established lower-level cleaning method, such as an alcohol wipe, for tonometer tips and lenses in routine care, following local infection-control policy.
- Apply high-level disinfection, or use a disposable tip, after examining a patient with suspected adenoviral or other ocular infection.
- Rinse and dry devices fully after any chemical disinfectant to avoid corneal toxicity.
- Inspect reusable tips and lenses for damage from repeated chemical exposure.
- Where local regulators still mandate high-level disinfection, follow the regulation while it stands.
Why it matters
It challenges a regulatory mandate that adds cost, waste and chemical injury without evidence of preventing infection.
Don't overread it
This is a professional position statement based on absence of evidence and a survey, not a trial; local regulations still apply.
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