Ocular Injury Risk in Children from Hand Sanitizers

Researchers from the Grewal Eye Institute, Chandigarh, India recently found out that small children are at risk of severe ocular injury and possibly even blindness due to inadvertent ocular exposure to alcohol-based hand rubs. The study is published in the JAMA Ophthalmology.

Hand hygiene is central to the prevention of transmission of severe acute respiratory syndrome coronavirus 2. The current literature illustrates the potential threat to skin and mucosal surfaces, especially the eyes, with use of alcohol-based hand rubs (ABHRs). As frequent hand sanitization is promoted worldwide because of the coronavirus disease 2019 pandemic, there have been reports of adverse health events due to ingestion of hand sanitizer by children.

Therefore, the authors studied a series of two case reports of toxic keratopathy in children after unintentional contact between ABHR and the eye, suggesting that increased awareness of this potential danger is needed.

Case Studies

First Case Study

In the first case study, a 4-year-old girl was brought by her parents with unintentional exposure of hand sanitizer to her right eye a day prior to examination. According to her parents, the child was attempting to use a sanitizer dispenser installed on a floor stand at a shop. Copious irrigation with balanced salt solution was performed in the operating room. Oral and topical medications were then initiated, including:

• Eye drops with moxifloxacin, 0.5%, twice hourly
• Eye drops with betamethasone, 0.5%, 6 times a day
• Carboxy methyl cellulose, 1%, hourly
• Homatropine, 1%, 2 times a day
• Timolol, 0.5%, 2 times a day
• Eye drops of vitamin C, 10%, 4 times a day
• Doxycycline, 100 mg, once daily
• Vitamin C, 250 mg, once a day

Second Case Study

However, in the second case study, a 5-year-old boy presented with a history of eye exposure to an ABHR 1 hour prior. A thorough saline wash was performed followed by topical medications, including:

• Eye drops with moxifloxacin, 0.5%, 6 times a day
• Eye drops with loteprednol etabonate, 0.5%, 3 times a day
• Eye drops with carboxy methyl cellulose, 1%, every 2 hours

With resolution of the ocular findings by day 5.

Discussion and Recommendations

Based on the findings of both the reports, it was discussed that "small children are at risk of severe ocular injury and possibly even blindness due to inadvertent ocular exposure to ABHRs. In most public places, the hand sanitizers are installed at a waist-level height of an adult but at eye level or above for a young child.

The authors further stated the following measures that can be followed:

• Promoting hand washing with soap and water over ABHRs, especially at home.
• Teaching and training children how to use hand sanitizers.
• Having separate dispensers at shops and malls for children, preferably at lower height (i.e., below face level).
• Placing caution signs next to sanitizer dispensers.

Therefore, it was concluded that "children should always be assisted by an adult while using ABHRs. Hand washing with soap and water should be promoted as a safer first-line preventive measure. As nations gear up to open public places and schools, it is necessary to consider the hazards of hand sanitizers and take appropriate preventive measures."