Reflected Surgical Lighting Exposure at the Mohs Surgeon's Eye Level: Quantifying Effects of Working Distance, Drape...

Mohs surgeons operate at close working distances under intense surgical illumination. Ocular symptoms, including eye strain and visual fatigue, are commonly reported, yet quantitative data on eye-level exposure to reflected surgical lighting are limited.

To quantify reflected surgical lighting at the Mohs surgeon's eye position and identify modifiable operative factors influencing ocular exposure.

This observational, device-based experimental study was conducted in a Mohs surgical suite using a simulated surgical model. Reflected illuminance was measured with a calibrated digital lux meter positioned at the surgeon's eye level. Overhead light-emitting diode lighting was fixed 40 inches from the surgical field. Measurements were obtained at eye-to-field distances of 14, 20, and 26 inches across 2 lamp orientations, 2 drape colors, and 3 simulated skin tone categories.

Reflected illuminance was highest at shorter working distances, measuring approximately 1.5 to 2.0 times higher at 14 inches than at 20 inches and up to 2 to 3 times higher than at 26 inches. White drapes increased reflected illuminance compared with blue drapes, while behind-the-surgeon lamp positioning reduced exposure compared with perpendicular lamp positioning. Skin tone had minimal impact.

Modifiable operative factors significantly influence ocular light exposure and represent low-cost strategies to reduce exposure without compromising visualization.