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Dr Brian Armstrong

Hand sanitisers 'can lead to severe eye injuries in children'

ABU DHABI, July 29, 2021

A doctor at Cleveland Clinic Abu Dhabi, an integral part of UAE's Mubadala Health, has sounded the alarm on severe ocular injuries in children caused by the unintentional exposure to hand sanitisers from self-dispensing units after the care team at the hospital successfully treated a four-year-old child with severe damage to her cornea.
 
The incident occurred when the child activated a foot-operated hand sanitiser station installed in a public place that she was visiting with her family and got hand sanitiser gel in her eye, a statement from the clinic said.
 
Her mother says that not many people are aware of chemicals in hand sanitisers that could be dangerous, especially for children.
 
“For purposes of hygiene, we’ve taught our daughter to use soap and water for washing her hands and to only use sanitisers if soap and water are not available, but because she saw everyone around her use it, she ran up ahead of us to use it too. When she pressed the pedal of the dispenser, the hand sanitiser didn’t fall downwards but instead a large amount went straight into her eye and she began screaming in pain,” the mother said.
 
The little girl's parents immediately irrigated her eye with water and took her home whilst continuing to wash her eye out. 
 
“We somehow were able to open her eye and we could clearly see the corneal injury. That’s when we decided to rush her to Cleveland Clinic Abu Dhabi because of their expertise in paediatric ophthalmology, and trusted that they’d know how to treat this specific case,” the mother added.
 
At the clinic's emergency department, doctors immediately washed the solution from the child’s eye, administered antibiotics to prevent infection and pain drops to reduce discomfort. She was diagnosed with a near total corneal abrasion caused by the alcohol and alkaline chemical additives in the hand gel. 
 
When the pain continued to escalate despite close follow-up over the following days by caregivers from the clinic’s Eye Institute, the child was taken to the operating room where doctors evaluated her eye under anaesthesia and placed a self-retaining amniotic membrane, or biological bandage used to heal large non-healing corneal abrasions.
 
Dr. Brian Armstrong, a staff physician in the Eye Institute, who was part of the care team that treated the child, said this was the first case of this nature that they have treated at the hospital that required amniotic membrane placement, but paediatric eye injuries from alcohol-based hand sanitisers have been on the rise around the world since the start of the pandemic. 
 
Earlier this year, the French Poison Control Centers reported seven times more cases of ocular exposure among children to hand sanitisers between April and August in 2020 compared to the same period in 2019.
 
Armstrong said: “Hand sanitiser dispensers installed in public spaces are often at waist-level for adults but this means that they are at eye-level for children. So, the chances of a child getting splashed in the eye are quite high. 
 
"Most hand sanitisers have a high concentration of alcohol, which starts to break down the surface of the cornea immediately. We use it in measured doses to treat the cornea in specific instances, so we know just how effective it can be,” he added.
 
“With this child, the pain may have increased over time as the alkaline solution penetrated deeper into her cornea. Immediate irrigation is advised in these cases, and manual opening of the eye may be required. It is important to irrigate away from the unaffected eye to prevent any further damage,” Armstrong explained.
 
Doctors removed the amniotic membrane a week after it was placed and found the corneal abrasion to be completely healed. However, the cornea was very dry and hazy, so doctors prescribed a course of medicated and lubricant eye drops. At the child’s next follow-up visit, the remaining findings had fully resolved. 
 
Armstrong advises parents to use soap and water preferably over hand sanitiser with their children wherever possible. “If this is not possible, parents should use neutral and natural hand sanitizing solutions under strict supervision and teach their children to use only a small amount making sure it completely dries prior to touching their eyes. 
 
"If they happen to rub their eyes with sanitizer, immediately wash it out with water and visit a hospital if there is blurred vision or pain," Armstrong added.
 
The child’s mother said the positive outcome was a result of swift action by them and the hospital.
 
“If treatment was delayed, this could have caused permanent vision damage. I really appreciate the prompt response of the emergency and ophthalmology teams at Cleveland Clinic and thank them for the attention and care that helped save my daughter’s eye,” she noted.
 
“Along with raising awareness among parents about the dangers of hand sanitisers for children, I’d like to advise them to take their children’s complaint about pain seriously and visit a hospital to avoid major problems," she added.
 
Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, is a multispecialty hospital on Al Maryah Island in the UAE.-TradeArabia News Service
 
Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, is a multispecialty hospital on Al Maryah Island in the UAE



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