July 28, 2020
Regular and thorough cleaning of hands has been advised since the start of the COVID-19 pandemic. This is to prevent the transfer of the virus from hands on to surfaces which others may touch. Washing your hands with soap and water, as well as the use of alcohol-based hand sanitisers are both recommended. Hand sanitisers have become more popular where there is no access to hand washing facilities and people are encouraged to use them in many shops and workplaces, as well as in health care settings.
People with facial palsy may need to take more care when using hand sanitiser. When you press the pump on the hand sanitiser it generates aerosols which are a potential threat to the skin and the surface of the eye. An allergic or inflammatory response can occur, particularly in those with pre-existing eye conditions, e.g. dry eye syndrome. Some people with facial palsy have reported that their non-blinking eye(s) is much more sore than normal after using hand sanitiser.
The key points from a recent medical paper1 state:
- Keep your eyes closed while pressing the nozzle of the sanitiser and while rubbing your hands. (This is not always possible for many people living with facial palsy)
- Make sure the sanitiser is kept below the eye level during usage.
- Avoid using sanitisers in a closed room with the air conditioner on.
- In case irritation occurs, use lubricant eyedrops.
Facial Palsy UK spoke to Mr Raman Malhotra (Consultant Ophthalmic and Oculoplastic Surgeon) from our Medical Advisory Board who explained that it is best not to put hand sanitiser on in an enclosed space, such as in the car. He recommends that people step out of the car to put hand sanitiser on. As well as taking the precautions mentioned above, Mr Malhotra recommended patients with facial palsy should look away and close their eye(s) as much as they are able to, whilst pressing the nozzle on the hand sanitiser and rubbing the hands. It is also important to wash your hands with soap and water before administering eye drops, to ensure you are not introducing hand sanitiser near the eye’s surface.
Karen Johnson, Deputy CEO of Facial Palsy UK said: “My left eye does not blink, and I have personally experienced a severely painful dry eye after repeated use of hand sanitiser. The problem is made worse because when your eye becomes sore you tend to rub it or try and use your fingers to close it. I had put hand sanitiser on in my car, then my eye became very painful and I was trying to hold the lower eyelid up to relieve the pain. I’m so used to having to support my eye in this way if it becomes dry and I simply didn’t think, I was causing further irritation because my hands were still covered in hand sanitiser, albeit rubbed in. The next day I had to tape my eye closed during the day as well as at night to relieve a sharp stabbing pain I was feeling in it, which made it difficult to work. I tried to think what I had done differently recently to cause the pain and realised I had used hand sanitiser much more frequently the day before because I had been out and about. Although I still use hand sanitiser where it is sensible to do so, I am much more careful about not using it in an enclosed space, I look away when putting it on, and don’t touch my eye afterwards. It is still mildly painful using it but not as bad as before.”
 Shetty R, Jayadev C, Chabra A, et al. Sanitizer aerosol-driven ocular surface disease (SADOSD)-A COVID-19 repercussion?. Indian J Ophthalmol. 2020;68(6):981-983. doi:10.4103/ijo.IJO_1308_20