The French Poison Control Centre has reported a sevenfold increase in alcohol-based hand-sanitiser (ABHS) ocular exposures in children in 2020, while in other countries paediatric ophthalmologists are sharing case studies and reporting increasing numbers of children requiring surgery for severe lesions.
Noting that ABHS is one of the main barriers for limiting the spread of Covid-19, the French review reported that, “the widespread use of ABHS has been associated with an increase in unintentional exposures since March 2020, especially in children.”
Recording 63 cases of ABHS exposure in a public space in 2020, versus none in 2019, the review found that all these cases involved public, foot-operated or automatic dispensers, which are frequently positioned around face height for the mean patient age (3.5 years) of children affected.
The review also said that while the World Health Organisation recommends ABHS be composed of 80% ethanol or 75% isopropanol, both regarded as irritants, a Korean study by Joo Youn Oh et al found that ethanol at that concentration had a cytotoxic effect on corneal epithelial cells, reduced proliferation and induced apoptosis. Other ABHS ingredients, such as hydrogen peroxide, polyethylene glycol (added to increase viscosity), perfumes, or essential oils, may also exacerbate ABHS’ ocular toxicity, reported the French researchers.
The full study by Dr Gilles Martin, from the Rothschild Foundation Hospital in Paris, and colleagues from the French Poison Control Centre was published in Jama Ophthalmology in January.