The explosive increase in the use of alcohol-based hand sanitizers during the COVID-19 pandemic has had a dangerous, unintended consequence: eye injuries to children.
Using data from France’s poison control and a children’s hospital in Paris, researchers reported accidental eye injuries in children under 18 years old last year, skyrocketing sevenfold over a five-month period, compared to 2019.
Eye injury from exposure to hand sanitizer “is a known complication,” said Dr. Sonal Tuli, a clinical spokeswoman for the American Academy of Ophthalmology (AAO) who reviewed the study’s findings.
“This is a concern not only for children, but also for adults and health professionals,” said Tuli. “As far as I know, there are no recent similar studies in the US, but I suspect similar injuries are occurring here as well.”
The new study was published online Jan. 21 in JAMA Ophthalmology.
Hand sanitizers mainly consist of ethanol or isopropyl alcohol (60% to 95%), which are toxic to delicate structures such as eyes, noted Dr. Sonam Yangzes, a consultant in lens, cornea and refractive services for Grewal Eye Institute in Chandigarh, India.
As such, exposure to disinfectants “can lead to blindness as a result of corneal ulcer development 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 Rothschild Foundation Hospital in Paris. He and his colleagues relied on 2019 and 2020 data collected by the French Poison Control Centers (PCCs) and a pediatric ophthalmic hospital in Paris.
The study included eye injuries and emergency calls from exposure to hand sanitizer in children under the age of 18.
Between April and August 2019, such cases accounted for about 1.3% of all calls to French PCCs. But that figure shot up to 9.9% over the same time frame in 2020, an increase of more than seven times.
That was 232 cases last year, up from 33 in 2019.
The good news: most cases were relatively mild, indicating eye pain, tingling or acute inflammation, swelling and / or discoloration (“conjunctival hyperaemia”).
The bad news: Six ‘moderately severe’ cases involved limited ‘keratitis,’ an inflammatory condition that affects the cornea. Several children had severe corneal lesions.
And while none of the cases in 2019 involved public exposure to hand sanitizer, 63 did in 2020, most of them in French malls.
Public exposure also occurred in restaurants, movie theaters, public areas, sports arenas and swimming pools through contact with an automatic or foot-operated dispenser.
In France (as in the United States), the availability of public dispensers skyrocketed as the pandemic spread. And in France, pediatric eye injuries seemed to be increasing simultaneously, according to the study.
This is likely because public dispensers for a small child are usually about 1 meter high – eye level, Martin and his team noted.
As such, Yangzes made a recommendation: “Lower the height of alcohol dispensers so that the level is under the eyes of the children [and] face, ”she insisted. As a precaution, a warning sign should be placed next to dispensers, ”she added.
According to Tuli of the AAO, disinfectant injuries can also occur if the alcohol has not yet evaporated and a child rubs his or her eyes.
“Usually, the blink reflex protects us from getting a lot of disinfectant into the eye, and tearing dilutes it,” she said. “So we’re seeing irritation similar to getting shampoo in the eyes.”
But if more than a small amount of sanitizer gets into the eye, Tuli said it can do more damage.
“It can cause corneal abrasions, in which the epithelium of the cornea or conjunctiva can become damaged, similar to a scratch on the eye from a fingernail injury. That can be very painful, but fortunately heals quickly,” Tuli said. “If a large amount gets into the eye, it can cause larger defects, which may require more surgery to heal.”
Because hand sanitizer is sterile, she added, infections or permanent damage are rare.