Kids and Corneal Injuries Caused by Public Hand Sanitizers

Alcohol based hand sanitizers (ABHS) although convenient, have proved to be a problem for children.  The pandemic has made it part of everyday life for young and old, but an unintentional consequence is the hazard for children, notably their eyes.  Pump dispensers located in every place of business are dangerously eye level for most children.

While adults conveniently place their hands at waste level, nearby kids are getting “wayward” squirts of sanitizer in their eyes.  Bottles placed on countertops offer a similar problem.  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.”

Many in eye care are raising awareness to this problem for kids and their corneas, calling for redesigns of the standalone dispenser, and height of the wall dispenser.  Others are calling for foam to be used versus gel, as the latter tends to “squirt” at angles.

It is recommended that children wash with soap and water whenever possible to avoid getting sanitizer in the eyes. When soap and water are not available, hand sanitizer should be used but application should be supervised by an adult.

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