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Can a Jewish Surgeon do eye-surgery on Shabbos
                                                                                                         in a Case of Emergency?

                                                                                                   1    Questions
                                   CIRCUMCISION ON A
                                   BABY WITH AN EYE                                            Question 1
               103  INFECTION                                                                     In ophthalmology there are several cases that would require urgent
                                                                                               surgery, mainly the situations listed below:

                                                                                                  1.  Endophthalmitis is a severe infection and inflammation of the
                                                                                                    eye, which generally appears after surgery or trauma. This is the
                   1    Question CiRcuMcision with an Eye Infection                                 most serious complication after surgery on the eye and every
                                                                                                    physician fears it. The treatment is removal of the urea from

               Every once in a while, I am called to examine a baby with an eye                     within the eye, the application of antibiotics into the eye, with
               infection and ascertain whether it is permissible to perform circum-                 or without a vitrectomy to clean out the infection from the in-
               cision. An examination of the baby gives me the impression that it                   side of the eye.
               is a lachrymal gland infection (an external and pain-free infection),              2.  Detachment of the retina, which endangers the macula, the cen-
               which is not associated with a general illness. Once the baby responds               ter of the retina which allows us to read and to recognize colors.
               positively to treatment, I believe the circumcision could be performed               When it is still attached, the surgery is to instill gas into the
               as soon as the infection is healed.                                                  eye together with treatment either by cryotherapy (freezing) or
                  In the past, it was common for newborns to develop acute eye                      laser surgery or surgery to repair retinal detachments by sewing
               infection transmitted from the mother during birth. Nowadays, in                     a flexible band of silicon around the eye.
               order to prevent such infections, every newborn is given a drop of                 3.  A penetrating wound, with or without a foreign body in the eye.
               silver nitrate immediately after birth. There is no doubt that before                Surgery includes first hand repair of the wound and removal of
               this form of preventative treatment became known, there was no way                   the foreign body as required
               to perform circumcision with an eye-infection. There are also various
               types of eye infections.                                                           Delay in performing surgery in these cases, even for only a few
                  I would be thankful if the honored Rav would answer this ques-               hours, is liable to worsen the situation in the eye and to result in a
               tion: What is the source for the prohibition of circumcising a baby             less than perfect outcome, even after successful surgery. In the case of
               with an eye infection, and which infection does the prohibition refer           severe endophthalmitis, delay in surgery is likely to endanger the eye
               to?                                                                             and to cause loss of vision and even loss of the eye.
                                                                                                  In view of the above, is it permitted to perform surgery in such cases
                                                          Dr. P. Nemet,                        on Yom Kippur, or on Shabbos, being that according to the physicians,
                                          Ichilov Medical Center, Tel Aviv                     these situations endanger the organ but are not pikuach nefesh?




        280              1  Medical-HalacHic Responsa of Rav ZilbeRstein                       Shabbos in an Ophthalmology Department  2                       301
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