To the Editor
As coronavirus disease 2019 (COVID-19) emerged and became pandemic, various nonpharmaceutical interventions had been employed to reduce the transmission. Alcohol-based hand sanitizers (ABHSs) can efficiently inactivate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); thus their use has been recommended by the World Health Organization and Centers for Disease Control and Prevention to reduce the risk of transmission via hands. 1
To facilitate the use, ABHSs are often provided in dispensers that are triggered either manually or automatically when build-in sensors are activated. As these dispensers become widely available in private and public places, a marked increase in unintentional ocular exposures was reported in the pediatric population. 2 Although most cases were in mild severity with symptoms of pain, tingling sensation, or conjunctival hyperemia, complete corneal and extensive conjunctival epithelial defects could be identified in severe cases. Prolonged time of re-epithelialization, and even the necessity of amniotic membrane transplant, have been reported in children with large and deep ulcers. 2 - 4
A 71-year-old lady was brought in by her family, accompanied by staff of a public place because accident eyes splatter of ABHSs happened before entering the place. No water irrigation was done on the scene and en-route to the hospital. On arrival, she had irritating, tearing red eyes, mild swelling of eyelids, and blurred vision. After thorough irrigation with 0.9% saline, superficial punctate keratitis in addition to diffuse keratoconjunctivitis was identified on her eyes. Conservative treatment with artificial tears was provided, and she had an uneventful recovery.
Despite the vital importance of ABHSs for controlling the transmission of COVID-19, these agents are harmful to eyes on exposure. Pediatric populations are the most commonly involved; however, adults are not free from the risk. Besides the precaution to keep away from children’s reach and proper use of the dispenser, it is vital to irrigate the eye on the scene as soon as possible with copious clean water or saline once eye splash happens. Such a simple first aid may save the eyes.
References
- 1. Kratzel A, Todt D, V’kovski P, et al. Inactivation of severe acute respiratory syndrome coronavirus 2 by WHO-recommended hand rub formulations and alcohols. Emerg Infect Dis . 2020;26:1592-1595. doi: 10.3201/eid2607.200915 [DOI] [PMC free article] [PubMed]
- 2. Martin GC, Le Roux G, Guindolet D, et al. Pediatric eye injuries by hydroalcoholic gel in the context of the coronavirus disease 2019 pandemic. JAMA Ophthalmol . 2021;139:348-351. doi: 10.1001/jamaophthalmol.2020.6346 [DOI] [PMC free article] [PubMed]
- 3. Becker CU, Salomão G, Serapião M, Manetta A, Nascimento H, Belfort Junior R. Letter to the editor: ocular surface injury following alcohol-based hand sanitizer use in Covid-19 prevention. Arq Bras Oftalmol . 2021;84:404-405. doi: 10.5935/0004-2749.202100105 [DOI] [PubMed]
- 4. Wasser LM, Koppel JH, Zadok D, et al. Pediatric ocular injury due to hand sanitizer exposure: an emerging hazard. Pediatr Emerg Care . 2021;37:462-465. doi: 10.1097/PEC.0000000000002468 [DOI] [PubMed]