March 2020

NEWS

Research Highlight
Children, older patients at increased risk for chemical ocular exposure


by Vanessa Caceres Contributing Writer

Ocular exposures to dangerous chemicals is most common in children under age 5, but there is also a growing number among adults age 65 and over, according to calls received to poison control centers reported in a study published in the American Journal of Ophthalmology.1
Depending on the chemical exposure, a person may experience lifelong vision loss, acute and chronic pain, or higher risk for infection. Additionally, injuries caused by alkali could harm deeper structures in the eye, such as the posterior segment and retina, the researchers noted.
Eye injuries cost $300 million annually in lost production time, medical expenses, and worker compensation, the authors reported, citing data from the U.S. Department of Labor. Because of both the potential eye damage and lost productivity, it’s important to track what causes ocular exposures due to dangerous chemicals to aid prevention.

What the study measured

The pooled, cross-sectional retrospective study focused on exposures reported to poison control centers from 2011–2015 in the U.S. During that time, the poison control centers received 477,274 calls related to ocular exposures, all of which were part of the National Poison Data System. The latter system is a data warehouse managed by the American Association of Poison Control Centers and is the surveillance database for 55 U.S. poison control centers.
Study authors noted major medical outcomes, reason for exposure, location of exposure, and causative xenobiotic.
An average of 95,454 calls were received each year, with the largest number of cases reported in 2011. There was nearly an equal number of calls from men (51%) and women.
The highest rates of incidence were in children under age 5. Year to year, there were fewer incidences of exposure except in those over age 64. The decline in exposure may be connected with improved education and a rise in child-resistant containers, the authors wrote.
Ocular exposures took place most frequently in the subjects’ homes (83%). The second most common place of exposure was at school for those under age 18 and at the workplace for those age 18 to 64. Workplace injuries declined with age.
Sixty-six percent of cases were managed onsite, while nearly a third presented to or were referred to a healthcare facility.
Common symptoms associated with exposures included eye pain, redness, burns, corneal abrasions, blurred vision, visual defects, papilledema, and lacrimation.
A permanent, significant visual disability occurred in 0.15% of cases; exposure to alkali was the most common agent that resulted in a permanent, significant visual disability.
Among children under age 10, 20 of them had a major outcome associated with laundry detergents and five from exposure to bleach. Among working adults, alkali exposure at the workplace was most commonly linked to a major outcome.
Pesticides were the most common reason for exposure (4.9%) among all patients, followed by wrong medication taken or given (3%) and incorrect dosing route (2%). The indication of wrong medication given was higher in those age 65 or over, increasing from a 10% incidence in those age 61 to 70 to 26% in those age 91 to 100. One common example of a wrong medication taken or given was a patient who uses eye drops but inadvertently exposes their eyes to something dangerous instead of their medicated drops, said Craig Heise, MD.
In 93% of cases, treatment was dilute/irrigate/wash. Seven percent received “other” treatment. Four percent of patients also were administered antibiotics.

Insights on the results

The study sheds some light on clinical trends and practical implications for both ophthalmologists and their patients.
“Most patients do well, but significant or permanent eye damage still occurs,” Dr. Heise said. “Simple steps in households and workplaces, encouraged by ophthalmologists, could probably significantly decrease these.”
The findings match what Ming Wang, MD, has seen in practice. “It’s all too easy to unintentionally expose the eyes to household chemicals with things such as laundry pods. We’ve even had staff members who have experienced this issue in their own home,” he said.
In addition to the large number of young children with ocular exposure, particularly related to detergent pods, physicians were intrigued by the growing number of exposures among older patients.
“More education should be provided on proper medication administration as well as labeling standards,” said Alena Reznik, MD.
“This [finding] parallels other studies in geriatric populations indicating issues with polypharmacy, polymorbidity, and inadequate geriatric assessment,” the study authors wrote. They also note that previous research (not necessarily related to ocular exposure) has found elderly abuse as a potential cause.
Although there are other steps that ophthalmologists can take to help patients reduce dangerous ocular exposures, there will always be injuries that eye doctors have to treat. “It’s unlikely a single eyecare office or even the concerted efforts of doctors can do much to prevent these types of injuries. Instead, eye doctors’ offices are the best resource for the treatment of these issues,” Dr. Wang said.

Tips to help reduce, prevent dangerous ocular exposures

1. Recommend that patients with young children keep detergents out of reach.
2. Advise all patients to handle laundry pods carefully.
3. Recommend that those in the workplace use eye protection if they are at risk for exposure to dangerous chemicals.
4. Help make patients aware of eye injuries caused by common offenders, including super glue, contact lens cleaning solution, and household cleaning supplies.
5. Encourage patients to read labels closely to see if a product can be used on the face or near the eyes.
6. Suggest keeping eye drops in a safe place to avoid inadvertent eye exposure to other household chemicals.
7. Let patients know to call the poison control center (800-222-1222) if an eye injury occurs with a chemical agent.

About the doctors

Craig William Heise, MD
Division of Medical Toxicology and Precision Medicine
Department of Clinical Data
Analytics and Decision Support
Department of Medicine
University of Arizona College of Medicine
Phoenix, Arizona

Alena Reznik, MD
Southern California Eye Institute at CHA Hollywood Presbyterian Medical Center
Los Angeles, California

Ming Wang, MD
Wang Vision 3D Cataract
& LASIK Center
Nashville, Tennessee

Reference

1. Heise CW and Agarwal S. Ocular exposures reported to poison control centers from 2011 to 2015. Am J Ophthalmol. 2019;204:46–50.

Relevant disclosures

Heise: None
Reznik: None
Wang: None

Contact

Heise: wheise@email.arizona.edu
Reznik: alena.reznik@sceyes.org
Wang: drwang@wangvisioninstitute.com

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