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The ongoing coronavirus disease 2019 (COVID-19) pandemic has produced widespread changes to our day-to-day lives in 2020. Many of us have spent the year working or going to school from home. Other interventions have been implemented to keep us and others safe when we do venture from home, including the wearing of face masks. Additionally, widespread availability of alcohol-based hand sanitizer, often in automatic, hands-free dispensers, has become commonplace in public places.
In this issue of JAMA Ophthalmology, authors1,2 from 2 different countries report eye injuries in children from inadvertent contact with alcohol-based hand sanitizer. Martin et al1 found a 7-fold increase in ocular exposure in children in 2020, with a corresponding increase in surgeries required to manage severe injuries resulting from these exposures.
Chemical injuries vary in severity, from mild and self-limited to severe and vision-threatening or even globe-threatening.3,4 The specter of amblyopia looms over even mild injuries in very young children. Recent work suggests that posterior segment inflammation can accompany ocular surface chemical injuries, further compounding the threat to visual acuity.5
Children are naturally curious and great mimics. We have seen in the recent past unintended adverse consequences for young children with new products, such as laundry detergent pods, which are appealing to children and can cause eye injury.6 With the current widespread use of hand sanitizer in public places, it is not unexpected that young children would be drawn to these dispensers, many of which appear to be inadvertently designed to facilitate contact between the hand sanitizer and young eyes.2
Since it appears that alcohol-based hand sanitizers are here to stay for at least the foreseeable future, what steps can be taken to protect children? First and foremost is raising awareness of the potential danger. The authors of these 2 articles1,2 are to be congratulated for alerting the ophthalmology community to this problem. It is likely that others have seen these injuries as well.
The next step is public education. Steps should be taken to isolate automated sanitizer dispensers from children. Redesign of dispensers, where possible, is important. Should an eye-wash station be part of an automatic sanitizer dispenser? This might not be practical, although it could be beneficial. At the very least, signage alerting people to the potential danger of contact with eyes should be posted. In an emergency, any clean liquid can be used to irrigate the eye following chemical exposure, and wording to this effect can be considered as part of a warning sign. Finally, parents need to understand the importance of an eye examination if any exposure occurs in children, since early diagnosis and treatment will reduce the long-term sequelae of chemical injury to the eyes.
It is a challenging time for the world. While we remain hopeful that vaccination and better treatment of COVID-19 will allow us to return to a more normal state in the not-too-distant future, we need to address this unintended consequence of the pandemic to reduce its effects on children.
Corresponding Author: Kathryn Colby, MD, PhD, New York University Grossman School of Medicine Department of Ophthalmology, 222 E 41st St, Fourth Floor, New York, NY 10017 (email@example.com).
Published Online: January 21, 2021. doi:10.1001/jamaophthalmol.2020.6327
Conflict of Interest Disclosures: None reported.
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Colby K. Unintended Consequences of Hand Sanitizer Use in the Coronavirus Disease 2019 Pandemic. JAMA Ophthalmol. 2021;139(3):352. doi:10.1001/jamaophthalmol.2020.6327
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