Alcohol-based hand sanitiser eye injuries

Proliferation of hygiene stations in public places putting children at risk.

Cheryl Guttman Krader

Posted: Sunday, March 28, 2021

Hygiene stations dispensing alcohol-based hand sanitisers (ABHS) have become ubiquitous in public places because of the COVID-19 pandemic. Recommendations from the World Health Organization note the need to adapt the equipment to encourage use by children while the United States Centers for Disease Control and Prevention warns about keeping ABHS out of the reach of children because of toxicity with ingestion.
Information in articles published January 21, 2021 online in JAMA Ophthalmology underscore that risk of potentially serious eye injury is another reason to keep ABHS away from
young children.
In a retrospective study, Gilles C. Martin, MD, MSc, et al. reviewed data collected by French Poison Control Centres during April through August in 2019 and 2020. They identified a sevenfold increase in ABHS-related ocular exposures in children in 2020 compared to 2019. In addition, they found a greater than 300% increase in the number of such cases occurring in public places between May and August 2020. In 2020, the involved children had a mean age of 4.5 years with 63 cases occurring from exposure in public places. Some 13% of children needed surgery.
Data from a tertiary ophthalmologic referral centre showed one child was admitted to the hospital for an ABHS injury in 2019 versus 16 children in 2020. In the latter cohort, eight children had a corneal and/or conjunctival ulcer and two required amniotic membrane transplantation.
In a separate article, authors from the Grewal Eye Institute in Chandigarh, India reported two cases of ABHS eye injuries in children aged 4 and 5 years, respectively. One child presented with a large central corneal epithelial defect and the other had conjunctival congestion and superficial punctate keratopathy.
The height of the ABHS dispenser of stations found in public places is often at face level in children, and the risk of serious eye injury is compounded by lack of access to water for flushing the eye. Suggested steps for preventing ABHS paediatric eye injuries include public health messages promoting soap and water as the preferred hand hygiene strategy, teaching children about using ABHS dispensers, providing separate equipment for children, and posting cautionary signs about eye exposure and what to do if it occurs.
In an invited commentary, Kathryn Colby, MD, PhD, Elisabeth J Cohen Professor and Chair of Ophthalmology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, congratulated the authors for alerting the ophthalmology community to this problem.
She told EuroTimes: “Ophthalmologists can help raise public awareness of this potential problem by reporting eye injuries that they see and by educating paediatricians and family practice providers in their community about the danger.”

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