FDA warns that getting alcohol-based hand sanitizer in the eyes can cause serious injury

We reviewed cases from U.S. poison control center calls and published articles in the medical literature^1,2 of serious ocular adverse events following accidental ocular exposure to an alcohol-based hand sanitizer.

We searched the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS) database between January 1, 2018, and April 30, 2021, and identified 3,642 cases of ocular-only exposures to an alcohol-based hand sanitizer with related ocular adverse effects. The most common related effects were eye irritation/pain and red eye/conjunctivitis. There were 58 cases of corneal abrasions and 160 cases of blurred vision. Of the 58 corneal abrasions, 51 were treated and released. The remainder were either unknown, lost to follow-up, or refused referral/did not arrive at the health care facility. Of the 51 cases treated and released, 27 had a moderate effect (more pronounced than minor symptoms but not life-threatening and without residual adverse effect), two had a major effect (life-threatening or resulted in residual adverse effect), and the remainder were either not followed or were minor. All 58 cases were treated with dilution/irrigation/wash and 26 of them also received antibiotics. Half of the corneal abrasion cases (n=29) occurred in children and teens 19 years and younger, and 21 percent (n=12) occurred in children 5 years and younger. In children 5 years of age and younger, most exposures occurred at home. In children 6 to 19 years of age, most exposures occurred in school settings.

We reviewed two publications describing a total of 18 cases of eye exposure to alcohol-based hand sanitizer in children, which required treatment in a hospital or by a health care professional. Martin et al.¹ described a case series of 16 children who were hospitalized at a pediatric ophthalmology referral center in 2020, an increase from one case in 2019. The average age of the children was 3.5 years. Eight of the 16 cases had a corneal and/or conjunctival ulcer. The median time between exposure and complete re-epithelialization for children with corneal ulcers was 13 days.

Yangzes et al.² described two pediatric cases of eye injury following ocular exposure to alcohol-based hand sanitizers. The first involved a 4-year-old girl who had an eye exposure while attempting to use a hand sanitizer dispenser at a shop. She complained of severe photophobia and had right eyelid edema. Findings included conjunctival ischemia and a large corneal epithelial defect. Treatment consisted of irrigation with saline solution, and oral and topical medications. The corneal defect resolved completely, and conjunctival ischemia resolved in 2 weeks. The second case involved a 5-year-old boy in whom ocular exposure to alcohol-based hand sanitizer resulted in conjunctival congestion with superficial punctate keratopathy. Treatment consisted of saline wash and topical medications, with ocular adverse events resolving by day 5.