“Chemical damage varies in depth from mild and self-limiting to extreme threat or global threat,” Kathryn Colby, MD, PhD, wrote in an accompanying statement.2 “The boom of amblyopia binds over even minor injuries in very young children. Recent work suggests that swelling of the posterior segment can be accompanied by ocular surface chemical injuries, increasing the risk for visual acuity. ”
For those exposed to chemical irritants, early diagnosis and treatment are extremely important as they can reduce the long-term sequelae of chemical eye injuries.
In an effort to quantify the transition of pediatric eye exposures to ABHS at the time of the pandemic and determine the severity of ocular injuries, the researchers conducted a post-national review. of French Poison Control Centers (PCCs) between April 1, 2020, and August 24, 2020. They compared cases of ocular exposure to chemical agents in children under 18 recorded in the National Database French Poisons during the 5 month period in 2020 and 2019.
In a subsequent case series study, they evaluated electronic medical records of children under 18 who consulted with the emergency department of a referral center in pediatric ophthalmology for the presence of an intravenous chemical agent. the 2 windows.
“Using 2 complementary datasets, we showed a 7-fold increase in the number of ABHS eye exposures in children with multiple cases of severe corneal injury,” the authors wrote.
Examination of national epidemiologic data revealed:
- The proportion of calls to PCCs related to chemical eye splatter in children was significantly lower compared to the same period in 2019: 2336 cases (2.2% of pediatric calls) in 2020 vs 2553 cases (4.2% of pediatric calls) in 2019 (difference, 2.0 percentage points 95% CI, 1.9–2.2; P.<.001)
- The proportion of ABHS eye exposures increased significantly, from 1.3% in 2019 (33 cases; average [SD] age, 3.4 [3.8] year) to 9.9% in 2020 (232 cases; average age, 4.5 [3.5] year) (difference, 8.6 percentage points; 95% CI, 7.4–9.9; P.<.001)
- The proportion of ABHS eye splatters increased significantly during the study period, from 5% in April 2020 to 9%, 10%, 11%, and 15% in May, June, July, and August 2020, respectively. .
- In 2020, there were 63 cases of ABHS exposure in a public place, none of which were reported in 2019
- Cases of ABHS exposures in public places continued to rise, from 5 May (1.0% of eye exposure; 12.2% of ABHS), to 9 in June (1.8% and 16.4%, respectively), to 16 in July, to 33 in August. (up to 24 August; 8.0% and 52.4%)
Although the case series found no difference between the two periods in terms of the proportion of chemical eye exposures among child populations, in 2019, 1 boy was admitted for exposure to ABHS compared to 16 cases of ABHS eye splatter admitted in 2020.
Of these 16 cases:
- 8 had a corneal and / or conjunctival ulcer, covering more than 50% of the corneal surface for 6
- 2 (12%) of these children required amniotic membrane transfusion (AMT) with general anesthesia after a median period of 3 days of medical treatment, due to delayed re-epithelialization.
- 1 case required AMT twice due to indeterminate re-epithelialization 10 days after the first AMT
Overall, the study “reveals collateral damages of widespread use of ABHS during COVID-19 pandemic disease and led to Heath’s general public warning” in France. The researchers speculated on the pediatric specificity of the revolution possibly due to the location of internal cleaning devices so close to children’s eyes. Weight transmitters are typically around 1 meter high.
Any delay in washing eyes after damage to the ocular surface. Two additional case reports published in Ophthalmology JAMA3 reporting toxic keratopathy in children after unexpected contact between alcohol-based hand rubs (ABHR) and the eye. Although ocular findings were resolved within 2 weeks in all cases, authors cautioned, “Toddlers are at risk of severe ocular injury and possibly even blindness due to adverse ocular effects on ABHR.”
Currently, the FDA recommends a concentration of 60% to 95% ethanol or isopropanol for ABHRs, but the composition is very variable. Eyes exposed to undamaged ethanol for more than 30 seconds can experience immediate cytotoxic effects on corneal epithelia cells while the substance reduces proliferation and promotes apoptosis. Adding irritant such as hydrogen peroxide, polyethylene glycol, or perfumes can also increase ocular poisoning.
To prevent risks of ocular injuries caused by ABHS, experts recommend that parents encourage hand washing with soap and water over ABHRs among children, especially when they are at home. . Children could be taught how to use detergents, have separate appliances at lower heights in public places, and put warning signs next to all dispensers to mitigate hazards. .
References
- Martin GC, Le Roux G, Guindolet D, et al. Pediatric eye injury with hydroalcoholic gel in the context of 2019 pandemic coronavirus infection. Ophthalmol JAMA. Published online January 21, 2021. doi: 10.1001 / jamaophthalmol.2020.6346
- Colby K. Unexpected effect of hand sanitizer use in 2019 coronavirus pandemic. Ophthalmol JAMA. Published online January 21, 2021. doi: 10.1001 / jamaophthalmol.2020.6327
- Yangzes S, Grewal S, Gailson T, Grewal SPS. Hand sanitizer-induces ocular injury: COVID-19 risk in children. Ophthalmol JAMA. Published online January 21, 2021. doi: 10.1001 / jamaophthalmol.2020.6351