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Phototherapy is a standard and effective treatment for neonatal hyperbilirubinemia, but when overhead phototherapy is used, protecting the infant’s eyes remains a routine part of care. Major clinical guidances, including the UK National Institute for Health and Care Excellence guidance (NICE NG98, 2016/updated 2023) and the American Academy of Pediatrics guidance (AAP Clinical Practice Guideline, 2022), recommend that babies receiving phototherapy are given eye protection together with routine eye care.
Although phototherapy is widely considered safe when used appropriately, clinicians are strongly advised to shield the eyes during treatment. The rationale is straightforward: eye protection helps prevent direct exposure to and retinal damage from high-intensity treatment light while therapy is underway. The precautionary principle and longstanding clinical consensus strongly support routine eye protection; a position reflected in the cleared indications for use of dedicated neonatal eye protectors such as Biliband®.
For eye protection to support safe and effective phototherapy, it should do four things well: fully cover the eyes with proper material to block the treatment light, stay securely in place during care and repositioning, avoid pressure on delicate tissues, and allow regular removal for eye assessment and routine care. Clinical nursing guidance also emphasizes that eye shields should not obstruct the nares and should be checked for drainage, irritation, pressure areas, or abrasion.
In practice, poor fit can create avoidable challenges. If the shield shifts, coverage may be compromised. If it is applied too tightly, it may increase the risk of pressure or skin-related issues. If it is difficult to remove and reapply, it can add time and disruption to routine care. Reliable eye protection therefore needs to balance secure coverage with gentle application and ease of use.
Eye protection should be applied with the infant’s eyes closed and should be checked regularly during treatment. Several hospital nursing guidelines recommend removing eye shields every 4 to 6 hours for eye care and assessment, ideally while the phototherapy light is turned off. During these checks, clinicians should assess for irritation, discharge, edema, abrasion, or signs of infection before replacing the shield and resuming treatment.
Guidance also makes clear that eye protection is only one part of good phototherapy practice. Effective treatment depends on maintaining phototherapy exposure, minimizing unnecessary interruptions, monitoring temperature and hydration, and supporting feeding and family-centered care throughout treatment. A practical eye protection solution should support, not complicate, these broader care goals.
In the NICU or nursery, repeated readjustment of eye protection can add handling and disrupt the flow of care. Products or methods that are difficult to position consistently may also increase the burden on staff during already time-sensitive treatment periods. From a workflow perspective, reliable eye protection is not just about coverage. It also matters because it should be simple to apply, stable during routine care, and straightforward to remove and replace during assessments. This supports more consistent treatment delivery and a smoother care process overall.
Published evidence comparing eye-shielding materials is limited, but a 2021 study assessing materials used during intensive phototherapy found that black cotton fabric, with or without foam padding, provided the strongest light shielding among the materials tested. While this is not a full clinical outcomes study, it does reinforce the importance of opacity and effective coverage when selecting or designing neonatal eye protection.
The Biliband’s eye pad is constructed as a multi-layer composite – a knitted blue outer fabric, a polyurethane sponge core, and a knitted black inner fabric — providing opaque coverage across the full phototherapy spectrum. The superiority of black fabric with foam design is also supported by independent published study (Abdulkadir, I., & Slusher, T. M. (2021). Neonatal eye shielding during phototherapy: What protects the eye better? Journal of Tropical Pediatrics, 67(6)). This multi-layer design achieves high opacity while supporting skin comfort and the absorption of any ocular discharge during treatment. Independent spectrophotometric testing (referenced in US Patent No. 6,973,930) demonstrates that Bili-Bands block 98.2–100% of light across wavelengths from 280 nm to 780 nm, encompassing the 425–475 nm blue-light range used therapeutically for bilirubin degradation.
When evaluating eye protection for neonatal phototherapy, the most important questions are practical ones:
Reliable eye protection should help clinicians protect the infant’s eyes while enabling phototherapy to proceed as smoothly and consistently as possible. That combination, coverage plus usability, is what matters most in practice.
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