The explosive increase in the use of alcohol-based hand sanitizers during the COVID-19 pandemic has had a dangerous and unintended consequence: eye injuries among children.
Using data from the French poison control and a children’s hospital in Paris, the researchers reported that accidental eye injuries in children under 18 multiplied by seven over a five-month period last year, compared with 2019.
Eye injury due to exposure to hand sanitizer “is a known complication,” said Dr. Sonal Tuli, a clinical spokesman for the American Academy of Ophthalmology (AAO) who reviewed the results of the study.
“This is a concern not only for children, but also for adults and health care workers,” Tuli said. “To my knowledge, there have been no recent similar studies in the United States, but I suspect there are similar injuries as well.”
The new study was published online Jan. 21 in JAMA Ophthalmology.
Hand sanitizers consist mainly of ethanol or isopropyl alcohol (60% to 95%), which are toxic to delicate structures such as the eyes, said Dr. Sonam Yangzes, consultant in the lens, cornea and refractive services division of the Grewal Eye Institute in Chandigarh, India.
As such, exposure to disinfectants “can lead to blindness, due to the development of ulcer or corneal fusion,” said Yangzes, who wrote an editorial accompanying the study. Increased use of the products during the COVID-19 pandemic has made “children more vulnerable to eye-related injuries,” he said.
The study was led by Dr. Gilles Martin, an ophthalmologist at the Rothschild Foundation Hospital in Paris. He and his colleagues relied on 2019 and 2020 data collected by the French Poison Control Centers (PCC) and a pediatric ophthalmology hospital in Paris.
The review included eye injuries and emergency calls resulting from exposure to hand sanitizer among under-18s.
Between April and August 2019, these cases accounted for approximately 1.3% of all calls to French CCPs. But that figure soared to 9.9% over the same time period in 2020, an increase of more than seven times.
This accounted for 232 cases last year, compared to 33 in 2019.
The good news: most cases had a relatively mild severity, i.e. some eye pain, tingling or acute swelling sensations, swelling and / or discoloration (“conjunctival hyperemia”).
The bad news: Six “moderately severe” cases involved limited “keratitis,” an inflammatory condition that affects the cornea. Several children had severe corneal injuries.
And while none of the 2019 cases involved public exposure to hand sanitizer, 63 did so in 2020, most in French malls.
The public exhibition also took place in restaurants, cinemas, open public spaces, sports centers and swimming pools through contact with an automatic or foot-controlled dispenser.
In France (as in the United States), the availability of public dispensers increased as the pandemic unfolded. And in France, pediatric eye injuries appeared to increase in tandem, according to the study.
This is likely because public dispensers are usually around 3 feet tall for young children, Martin and his team noted.
As such, Yangzes offered a recommendation: “Lower the height of the alcohol dispensers so that the level is below the children’s eyes. [and] “She insisted. A caution sign should be placed next to the dispensers as a precaution,” she added.
Tuli, of the AAO, noted that disinfectant-related injuries can also occur when alcohol has not yet evaporated and a child is rubbing their eyes.
“Normally, the blinking reflex protects us from many disinfectants entering the eye and the dilution diluting it,” he said. “So we see an irritation similar to that of shampooing the eyes.”
But if more than a small amount of disinfectant comes into view, Tuli said it can cause more damage.
“It can cause corneal abrasions, where the epithelium of the cornea or conjunctiva can be damaged, similar to a scratch on the eye due to a nail injury. This can be very painful, but fortunately it heals quickly,” he said. dir Tuli. “If a large amount enters the eye, it can cause larger defects, which may require more interventions to heal.”
Because hand sanitizer is sterile, he added, infections or permanent damage are rare.