The explosive increase in the use of alcohol-based hand sanitizers during the COVID-19 pandemic had a dangerous and unintended consequence: eye damage in children.
Using data from French poison control and a children’s hospital in Paris, the researchers reported accidental eye injuries in children under 18 that increased sevenfold over a five-month period last year, compared to 2019.
Eye damage due to exposure to hand sanitizer “is a known complication,” said Dr. Sonal Tuli, clinical spokeswoman for the American Academy of Ophthalmology (AAO) who reviewed the study results.
“This is a concern not only for children, but also for adults and health professionals,” said Tuli. “To my knowledge, there have been no recent similar studies in the United States, but I suspect that there are similar injuries here as well.”
The new study was published online on January 21 in JAMA Ophthalmology.
Hand sanitizers mainly consist of ethanol or isopropyl alcohol (60% to 95%), which are toxic to delicate structures such as the eyes, noted Dr. Sonam Yangzes, consultant in the lens, cornea and refractive services division at the Grewal Eye Institute in Chandigarh, India.
As such, exposure to disinfectants “can lead to blindness due to the development of corneal ulcers or melting,” said Yangzes, who co-wrote an editorial that accompanied the study. The increasing use of products during the COVID-19 pandemic has made “children more vulnerable to eye damage,” she said.
The study was conducted by Dr. Gilles Martin, an ophthalmologist at the Rothschild Foundation Hospital in Paris. He and his colleagues trusted the 2019 and 2020 data collected by the French Poison Control Centers (PCCs) and a pediatric ophthalmology hospital in Paris.
The review included eye injuries and emergency calls arising from exposure to hand sanitizer among children under 18 years of age.
Between April and August 2019, these cases accounted for about 1.3% of all calls to French CCPs. But that number soared to 9.9% during the same period in 2020, an increase of more than seven times.
That represented 232 cases last year, up from 33 in 2019.
The good news: most cases were relatively mild in severity, which means some eye pain, a tingling sensation or acute inflammation, 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, mostly in French shopping malls.
Public exposure also took place in restaurants, cinemas, open public spaces, sports stadiums and swimming pools through contact with an automatic distributor or pedal.
In France (as well as in the United States), the availability of public dispensers has skyrocketed as the pandemic unfolds. And in France, pediatric eye injuries appeared to increase together, according to the study.
This is probably because public distributors are typically about 1 meter tall at eye level, a small child, noted Martin and his team.
As such, Yangzes offered a recommendation: “Lower the height of the alcohol packs so that the level is below the eyes of the children [and] face, “she asked. A caution sign should be placed next to the dispensers as a precaution, she added.
Tuli, from AAO, noted that injuries related to disinfectant can also occur when the alcohol has not yet evaporated and the child rubs his eyes.
“Usually, the blinking reflex protects us from too much disinfectant getting into the eye and the tearing dilutes it,” she said. “So, we see irritation similar to putting shampoo in the eyes.”
But if more than a small amount of disinfectant reaches the eyes, Tuli said it could cause more damage.
“It can cause abrasions on the cornea, where the corneal or conjunctiva epithelium can be damaged, similar to a scratch in the eye caused by a nail injury. This can be very painful, but fortunately it heals quickly,” said Tuli. “If a large amount enters the eye, it can cause larger defects, which may require more interventions to heal.”
Because the hand sanitizer is sterile, she added, infections or permanent damage are rare.