Objectives <p>The use of handheld dental X-ray devices has been increasing, raising concerns about operator radiation exposure. This study evaluated the effects of handheld dental X-ray device positioning and protective eyewear on the absorbed dose received by the operator’s eye lens and pituitary gland.</p> Methods <p>Calibrated optically stimulated luminescent dosimeters were placed at the eye lens and sphenoid regions of an anthropomorphic head phantom. Measurements were obtained under different device positioning scenarios, with and without protective eyewear. Four operator positions were evaluated, and 30 repeated irradiations were performed under each condition, both with and without protective eyewear, resulting in a total of 720 individual measurements.</p> Results <p>Both operator positioning and the use of protective eyewear significantly influenced absorbed dose levels. Protective eyewear reduced ocular and sphenoidal exposure across all evaluated positions, with the greatest reduction observed when combined with optimal device angulation. Across all positions, the use of protective eyewear decreased absorbed dose by approximately 48–70% (<i>p</i> &lt; 0.001 for all comparisons), with the largest reductions observed under the shielding condition.</p> Conclusions <p>Appropriate operator positioning and the consistent use of protective eyewear are essential for minimizing radiation exposure to radiosensitive structures during handheld dental X-ray procedures. Under the conditions evaluated in this phantom study, the combination of a 45° device angulation and protective eyewear resulted in the lowest absorbed dose values, suggesting that this approach may help reduce operator radiation exposure.</p> Clinical trial number <p>Not applicable.</p>