Eyes and alkalis. Wave of paediatric eye injuries from liquid detergent capsules.

We highlight a new wave of paediatric ocular surface injuries. In 2001 the cleaning products industry produced liquid capsules for fabric detergents. Last year chemical injuries associated with these capsules accounted for 40% of ocular chemical injuries in children under the age of 5 at this hospital. Guy’s and St Thomas’ Poisons Unit received 192 enquires related to the capsules during 2007-8 and 225 calls during 2006-7, a fifth of which related to ocular exposure. In our case series of 13 children (mean age 23.9 months, range 14-34 months; nine girls), corneal burns resolved with no sequelae in 12 cases (table). However, one child (case 1) received ocular irrigation only on arrival in accident and emergency and therefore sustained bilateral total corneal epithelial burns. The capsule in most liquid detergent capsules is a water soluble polyvinyl alcohol membrane. The liquid detergent is a mixture of three active agents—an anionic detergent (20-30%), a non-ionic detergent, and a cationic surfactant—dissolved in water to give an alkaline solution, making the capsule more dangerous than initially perceived. Alkali injuries are the most severe form of ocular chemical injury and can cause irreversible damage to all anterior ocular structures and have lifelong ramifications. Any visual deprivation from a non-healing corneal epithelial defect or from subepithelial scarring in children can also lead to amblyopia. After recent discussions with Guy’s Poisons Unit, some manufacturers have made hazard labels more prominent. But greater consumer awareness is required to reduce injury. Such concentrated cleaning products must be kept out of the reach of children, and immediate irrigation is crucial to reduce the risk of clinically significant injury.