Alcohol based hand sanitizers (ABHS) are everywhere. Grocery stores, gyms, doctor offices, shops, and schools. Convenient and necessary during pandemic times when soap and water are not available. A downside for convenience is the height of the dispensers themselves. Eye professionals are seeing a higher number of children with corneal damage than pre-pandemic times. The culprit seems to be the actual dispensers themselves, specifically the height of the dispensers.
Next time you stop at a dispenser, consider the height, and angle of the dispense. Did it spray down into your hand, or was it wayward? Chances are the devise squirted at an angle. For a child, the level of the spray and unpredictability of the “squirt” can wreak havoc on their eyes. Even shared bottle dispensers that are placed on a shelf, table or on top of the reception desk at a doctor’s office could be a cause for concern if at the wrong height for kids who may also be tempted to use them. Recent reports have revealed that dispensers placed at or above the eye levels of children have resulted in them sustaining corneal and conjunctival injuries by accidentally getting hand sanitizer squirted in their eyes.
In January 2021, Yangzes et al published two case studies of eye injuries in kids due to ABHS in JAMA Ophthalmology. They say “small children are at risk of severe ocular injury and possibly even blindness due to inadvertent ocular exposure to ABHS. 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.” They go on to say that “for ABHS, the US Food and Drug Administration recommends a concentration of 60% to 95% ethanol or isopropanol. The irritant in our case report was 70% ethyl alcohol, which led to total loss of corneal epithelium along with conjunctival ischemia in one case and localized epitheliopathy in the other.” The two patients in their cases were lucky and were treated promptly. They did not go on to have any permanent corneal or ocular damage, however they do warn that there are other published cases on alcohol-based eye injuries in which subjects were not as lucky.
Also this year, Martin et al performed a retrospective review of ABHS cases from the French Poison Control Centers, which indicated that “a 7-fold increase of alcohol-based hand sanitizer-related ocular exposures in children was found [in 2020] in comparison with 2019, and a pediatric ophthalmology center reported 13% of [those] patients requiring surgery for severe lesions.” Dr. Martin says that “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 during 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.”
Eye care professionals are raising awareness for this hazard. Some are asking for a redesign of dispensers, and advocate foam versus gel to control spatter.
All health professionals including eye doctors emphasize the use of soap and water whenever possible, but for those situations that sanitizer is needed, adult supervision is recommended.