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Hand sanitizer has become much more common because of COVID-19. Has this ubiquity increased eye injuries in children?
The COVID-19 pandemic has led to many alterations in behavior, such as maintaining distance from others and always reaching for a mask before walking outside. Another change is the proliferation of hand sanitizers being used much more frequently. A report in JAMA Ophthalmology examines whether the increased use was linked to an increase in severe ocular lesions.1
The researchers ran a retrospective case series from April 2020 to August 2020. The cases came from either the national database of the French Poison Control Centers as well as a pediatric ophthalmology referral hospital in Paris. Any case of ocular exposure to a chemical exposure in a child aged younger than 18 years was examined. Data on sex, age, circumstances of exposure, symptoms, size of the epithelial defect at first examination, time between the incident and re-epithelialization, and medical and/or surgical management were collected. The researchers compared the number of eye exposures to alcohol-based hand sanitizer in children between April to August 2020 and April to August 2019.
The researchers found in the poison control database that there were 7 times more pediatric cases of exposure to alcohol-based hand sanitizers between April and August 2020 than in the same period of time in 2019 (9.9% of pediatric eye exposures in 2020 vs 1.3% in 2019; difference, 8.6%; 95% CI, 7.4-9.9; P < .001). Within the period in 2020, there was also a marked increase in the cases that occurred in a public space from 16.4% in May to 52.4% in August. In the hospital setting, the admissions for exposure to alcohol-based hand sanitizer also increased in the same time period (16 children in 2020 including 10 boys; average age, 3.5 years vs 1 boy aged 16 months in 2019). Eight of the children had a corneal and/or conjunctival ulcer and 6 of the cases involved more than 50% of the corneal surface. An amniotic membrane transplant was necessary for 2 cases.
The reviewers said that the data supports the likelihood of unintentional exposure to alcohol-based hand sanitizer. To ensure that children are safe and to support continued use of hand sanitizer use, the researchers urge clinicians to warn parents and caregivers about the potential danger that alcohol-based hand sanitizer can pose to children’s eyes.
1. Martin G, Le Roux G, Guindolet D, et al. Pediatric eye injuries by hydroalcoholic gel in the context of the coronavirus disease 2019 pandemic. JAMA Ophthalmol. January 21, 2021. Epub ahead of print. doi:10.1001/jamaophthalmol.2020.634