Hand sanitizer associated corneal burns increasing due to COVID-19

As a result of the COVID-19 pandemic, people around the world are now practicing strict personal hygiene against infection.  This includes the regular use of alcohol-based hand sanitizers.  A recent paper in the Visual Journal of Emergency Medicine reported on a surge in hand sanitizer associated ocular chemical injury to the marked increase in the use of hand sanitizers over the last year.  In particular, there has been a rise in the number of emergency patients presenting to eye care practitioners and hospitals with immense ocular pain associated with a corneal alcohol burn that – after use of the hand sanitizer – has been caused by accidental application of the residual alcohol from the fingers onto the eye.  We have seen one such case in our practice where a contact lens patient presented with a corneal alcohol burn on her right eye which presumably occurred due to accidental administration of alcohol from the fingers onto the eye when she was inserting her contact lens.  I am also aware of three other cases that have occurred in clinical practice from discussion with my colleagues and in each of these cases the patient concerned was also a contact lens wearer.

 

Thankfully, while corneal alcohol burns are extremely painful, the alcohol will usually cause a self-limiting, albeit significant, keratitis which is generally confined to the outer layer (epithelium) of the cornea.  There may also be some associated inflammation of the conjunctiva.  The eye usually recovers within about 6 to 12 hours and there are no lasting side effects or structural changes such as corneal scarring.  Generally, the frequent use of ocular lubricants is required to help make the eye more comfortable while the cornea is recovering, however if the pain is substantial the addition of topical non-steroidal anti-inflammatory eye drops may be beneficial and strong cycloplegic eye drops can also be used to ameliorate secondary inflammation.  For those patients who are extremely symptomatic, oral narcotic analgesics such as Panadol may also be used.

 

Prevention is the best form of treatment for corneal alcohol burns.  The isopropyl alcohol in hand sanitizers does evaporate relatively quickly, however after using the hand sanitizer patients should be advised that they need to wait at least two minutes for the residual alcohol to evaporate from their fingers before they bring their fingers into contact with their eyes whether it be for insertion of a contact lens, application of make up or some other reason.  A safer option is probably not to use a hand sanitizer, but rather a mild lanolin-free soap or an antibacterial liquid hand cleaner that does not have an alcohol base.  Should alcohol accidentally come into contact with the eye, the key thing is not to get flustered even though the pain may be quite severe.  Do seek immediate attention from your eye care practitioner.  Prior to attending for this emergency appointment, you may also want to irrigate the eye for at least 10 minutes with water from the shower, garden hose, etc although this is not absolutely essential since – as was mentioned earlier – the alcohol does not cause any permanent damage to the eye.