The explosive increase in the use of alcohol-based hand sanitizers during the COVID-19 pandemic had a dangerous, unintended consequence: eye damage among children.
Using data from the French Poison Control and a children’s hospital in Paris, the researchers reported accidental eye injuries to children under the age of 18 shot seven times over a five-month period last year compared to 2019.
Eye injuries caused by exposure to hand sanitizer “are a known complication,” said Dr. Sonal Tuli, a clinical spokeswoman 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 workers,” Tuli said. “As far as I know, there have been no similar recent studies in the United States, but I suspect that there are similar lesions that occur here.”
The new study was published online on January 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, a consultant in the division of lenses, cornea and refraction services for Grewal Eye Institute in Chandigarh, India.
As such, exposure to hygiene products “can lead to blindness due to the development of corneal ulcer or melting,” said Yangzes, who co-wrote an editorial accompanying the study. Increased use of the products during the COVID-19 pandemic has made “children more vulnerable to eye damage,” she 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 (CCP) and a pediatric ophthalmology hospital in Paris.
The review included eye injuries and emergency calls resulting from exposure to hand sanitizer in children under 18 years of age.
Between April and August 2019, such cases accounted for approximately 1.3% of all appeals to French CCPs. But that figure rose to 9.9% over the same period in 2020, an increase of more than seven times.
That was 232 cases last year, compared to 33 in 2019.
The good news: Most cases were relatively mild in severity, which means some eye pain, tingling 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 malls.
The public exhibition also took place in restaurants, cinemas, open public spaces, sports arenas and swimming pools, through contact with a vending machine or foot-controlled.
In France (as in the United States), the availability of public distributors increased as the pandemic unfolded. And in France, pediatric eye damage appears to be growing in tandem, according to the study.
This is probably because public dispensers are usually about 3 feet high – the eye level for a small child, Martin and his team noted.
As such, Yangzes offered a recommendation: “Reduce the height of alcohol dispensers so that the level is below the eyes of children. [and] “A precautionary sign should be placed next to dispensers as a precautionary measure,” she added.
Tuli from AAO noted that disinfectant-related lesions can also occur when the alcohol has not yet evaporated and a child is rubbing his eyes.
“Usually, the blink reflex protects us from a lot of disinfectants that get into the eyes and the tear dilutes it,” she said. “So we see an irritation similar to the introduction of shampoo into the eyes.”
But if more than a small amount of disinfectant gets to the eyes, Tuli said it can do more damage.
“It can cause corneal abrasions, in which 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,” Tuli said. “If a large amount gets into the eyes, it can cause larger defects, which may require more interventions to heal.”
Because hand sanitizer is sterile, she added, permanent infections or injuries are rare.