Pediatric Eye Injuries by Hydroalcoholic Gel in the Context of the Coronavirus Disease 2019 Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has made alcohol-based hand sanitizers (ABHS) widely available in public places. This may warrant determining whether cases of unintentional ocular exposure are increasing, especially in children.OBJECTIVE To describe the epidemiologic trend of pediatric eye exposures to ABHS and to report the severity of the ocular lesions. DESIGN, SETTING, AND PARTICIPANTSRetrospective case series conducted from April 1, 2020, to August 24, 2020. Cases were retrieved from the national database of the French Poison Control Centers (PCC) and from a pediatric ophthalmology referral hospital in Paris, France. Cases of ocular exposure to chemical agents in children younger than 18 years during the study period were reviewed. Cases of ABHS exposure were included.EXPOSURES The following data were collected: age, sex, 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. MAIN OUTCOMES AND MEASURESComparison of the number of eye exposures to ABHS in children between April to August 2020 and April to August 2019. RESULTSBetween April 1 and August 24, 2020, there were 7 times more pediatric cases of ABHS eye exposures reported in the PCC database compared with the same period 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). The number of cases occurring in public places increased in 2020 (from 16.4% in May to 52.4% in August). Similarly, admissions to the eye hospital for ABHS exposure increased at the same period (16 children in 2020 including 10 boys; mean [SD] age, 3.5 [1.4] years vs 1 boy aged 16 months in 2019). Eight of them presented with a corneal and/or conjunctival ulcer, involving more than 50% of the corneal surface for 6 of them. Two cases required amniotic membrane transplant.CONCLUSIONS AND RELEVANCE These data support the likelihood of an increasing number of unintentional ocular exposures to ABHS in the pediatric population. To maintain good public compliance with hand disinfection, these findings support that health authorities should ensure the safe use of these devices and warn the parents and caregivers about their potential danger for children.

Event-Based Surveillance of Poisonings and Potentially Hazardous Exposures over 12 Months of the COVID-19 Pandemic

“…However, more severe paediatric exposures to HS in public places (including a school and hospital) were reported in Australia, the United Arab Emirates, the United Kingdom and France [ 43 , 44 , 45 , 46 ]. A peer-reviewed study from France found that that the frequency and severity of ocular HS exposures in children were likely, in part, driven by the height of public dispensers relative to the child, the viscosity of some preparations and also delays in finding a water source to flush the sanitiser from the eye [ 47 ]. There were also reports of people being injured after using highly concentrated methanol solutions to clean their home or face mask [ 48 , 49 ].…”

“…The following are available online at , Table S1: Regional Classifications Used during Data Processing, Table S2: High-level Summary of Potential COVID-related Poisoning Risks Identified Over the Course of the Study Period. References [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ,…”

Alcohol-Based Hand Sanitizers in COVID-19 Prevention: A Multidimensional Perspective

“…Another related potentially adverse topical effect that has been reported in the literature recently is accidental ocular exposure to ABHS [89][90][91]. It is therefore important that ABHS users be made aware of this risk and use by children be carefully monitored by an adult.…”

Unravelling the Enigma of Hand Sanitizer In COVID-19 – A Bibliometric Analysis of Related Publications Over the Year

“…Croatian Poison Control Centre reported about a nine times increase in sanitizer exposure cases in the rst half of 2020, where preschool children have been the most vulnerable group (Babić et al 2020). Apart from oral ingestion, ABHS-related ocular exposures in children have increased in comparison with the earlier year (Martin et al 2021), though without long-term sequelae (Yangzes et al 2021).…”