Pediatric Eye Injuries by Hydroalcoholic Gel in the Context of the Coronavirus Disease 2019 Pandemic | Ophthalmology | JAMA Ophthalmology | JAMA Network
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    Brief Report
    January 21, 2021

    Pediatric Eye Injuries by Hydroalcoholic Gel in the Context of the Coronavirus Disease 2019 Pandemic

    Author Affiliations
    • 1Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
    • 2CHU Angers, Poison Control Center of West France, Angers, France
    • 3UNIV Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail, Angers, France
    • 4Paris University, Paris, France
    • 5Cornouailles Hospital, Ophthalmology Department, Quimper, France
    • 6Centre antipoison et de Toxicovigilance de Paris, Assistance Publique des Hôpitaux de Paris - Hôpital Fernand Widal, Paris, France
    • 7Université de Paris, UFR de médecine, Paris, France
    • 8INSERM UMRS 1144, Faculté de Pharmacie de Paris, Paris, France
    JAMA Ophthalmol. 2021;139(3):348-351. doi:10.1001/jamaophthalmol.2020.6346
    Key Points

    Question  Is there an increase in severe ocular lesions associated with alcohol-based hand sanitizer exposures in children since March 2020?

    Findings  In this national retrospective review from the French Poison Control Centers, a 7-fold increase of alcohol-based hand sanitizer-related ocular exposures in children was found in comparison with 2019, and a pediatric ophthalmology center reported 13% of patients requiring surgery for severe lesions.

    Meaning  These findings support that, despite the importance of alcohol-based hand sanitizers for controlling the spread of coronavirus disease 2019, these agents should be used with caution and likely kept away from young children.


    Importance  The coronavirus disease 2019 (COVID-19) pandemic has made alcohol-based hand sanitizers (ABHS) widely available in public places. This may warrant determining whether cases of unintentional ocular exposure are increasing, especially in children.

    Objective  To describe the epidemiologic trend of pediatric eye exposures to ABHS and to report the severity of the ocular lesions.

    Design, Setting, and Participants  Retrospective case series conducted from April 1, 2020, to August 24, 2020. Cases were retrieved from the national database of the French Poison Control Centers (PCC) and from a pediatric ophthalmology referral hospital in Paris, France. Cases of ocular exposure to chemical agents in children younger than 18 years during the study period were reviewed. Cases of ABHS exposure were included.

    Exposures  The following data were collected: age, sex, circumstances of exposure, symptoms, size of the epithelial defect at first examination, time between the incident and re-epithelialization, and medical and/or surgical management.

    Main Outcomes and Measures  Comparison of the number of eye exposures to ABHS in children between April to August 2020 and April to August 2019.

    Results  Between April 1 and August 24, 2020, there were 7 times more pediatric cases of ABHS eye exposures reported in the PCC database compared with the same period in 2019 (9.9% of pediatric eye exposures in 2020 vs 1.3% in 2019; difference, 8.6%; 95% CI, 7.4-9.9; P < .001). 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 at 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.

    Conclusions and Relevance  These data support the likelihood of an increasing number of unintentional ocular exposures to ABHS in the pediatric population. To maintain good public compliance with hand disinfection, these findings support that health authorities should ensure the safe use of these devices and warn the parents and caregivers about their potential danger for children.