Possible iatrogenic transmission of Creutzfeldt-Jakob disease via tonometer tips: a review of the literature

Optometry. 2001 Oct;72(10):649-52.


Background: Tonometer tips are used by optometrists to measure intraocular pressures. The recommended procedure of soaking in bleach solution kills bacteria and certain viruses, such as human immunodeficiency virus, herpes simplex virus-1 and herpes simplex virus-2, adenovirus 8, and hepatitis B, from the tip. Conversely, recommendations made in literature to sterilize equipment that may have come in contact with virus-contaminated tissue from patients with Creutzfeldt-Jakob disease have a somewhat tougher requirement.

Methods: Autoclaving for 1 hour at a temperature of at least 120 degrees C (15 psi), or a 1-hour exposure to 0.5% sodium hypochlorite (a 10-fold dilution of household bleach) should provide excellent disinfection. One-hour exposure to 1 N Sodium hydroxide has also been mentioned in the literature.

Results: Studies have shown that corneas of guinea pigs with Cruetzfeldt-Jakob disease (C-J disease) are infectious. Infected corneas have been shown to cause transmission via corneal transplants, and via experimental placement of infected guinea pig's cornea into the anterior chamber of uninfected guinea pigs. Many researchers have strongly suggested that C-J disease can be iatrogenically transmitted via applanation tonometer tips. An epidemiologic case-controlled study found statistically significant odds ratio for intraocular pressure testing in the medical history of patients with C-J disease.

Conclusion: Even though there have not been any proven studies confirming iatrogenic transmission through tonometer tips, optometrists should be cautious if a patient has C-J disease, or manifests symptoms of C-J disease and use alternatives to Goldmann applanation tonometry.

Publication types

  • Review

MeSH terms

  • Animals
  • Creutzfeldt-Jakob Syndrome / diagnosis
  • Creutzfeldt-Jakob Syndrome / transmission*
  • Disease Transmission, Infectious / prevention & control*
  • Disinfection / methods
  • Humans
  • Iatrogenic Disease
  • Intraocular Pressure
  • Prions / pathogenicity
  • Tonometry, Ocular / adverse effects*


  • Prions