By Catherine Saint Louis, New York Times

Accidents involving chemicals splashed in the eyes were long regarded as a workplace risk.

But it turns out that toddlers have the highest risk for this potentially blinding injury at home, according to a study published in JAMA Ophthalmology last month. Before a parent can stop them, curious babies may spray themselves in the face with a household cleaner or squeeze a liquid detergent packet till it explodes.

Most parents know to keep liquid cleaning products out of children’s reach so they do not drink them, but may be unaware that even products like toilet cleaning sprays and alcohol-based hand sanitizers must be kept out of reach.

Chemical eye burns from industrial chemicals and cleaning products are usually considered a problem in industrial settings. That is why the Occupational Safety and Health Administration mandates the use of safety goggles and face shields in certain jobs.

Using a database of 900 emergency departments nationwide, researchers found that 1- and 2-year-olds had the highest rates of eye injuries from chemicals. Roughly 28 out of 100,000 1-year-olds and 23 out of every 100,000 2-year-olds had chemical eye burns while only 13 out of every 100,000 adults ages 18-64 did.

“Just about every eye doctor has seen this,” said Dr. Alex Levin, chief of pediatric ophthalmology at Wills Eye Hospital in Philadelphia, who did not participate in the new study. “It’s a potentially blinding problem that is a completely preventable tragedy.”

Household detergents are nothing new, of course. But “nobody had ever really looked at chemical ocular burns on a national scale,” said Dr. R. Sterling Haring, the study’s first author and a former fellow at Harvard Medical School and Brigham and Women’s Hospital. So “we didn’t know the relative volume of kids with these injuries relative to adults.”

From 2010 to 2013, there were roughly 144,000 chemical eye burns totaling $106.7 million in emergency-department charges, the study found. Most happened at home, not work.

“What they are describing is the tip of the iceberg,” said Dr. Kevin Osterhoudt, an emergency room physician and the medical director of the poison control center at Children’s Hospital of Philadelphia.

For instance, the analysis did not include patients who went to urgent care centers or straight to an ophthalmologist. In addition, Osterhoudt said other patients called a poison control center, like his, to get help managing a chemical eye burn and never went to an ER.

Costs of chemical eye burns are also underestimated, he said, because this study did not account for loss of work, hospitalizations or follow-up visits to eye doctors for continuing care.

Such accidents are emergencies. After a chemical gets into it, an eye must immediately be flushed with water, under the sink or in the bath, for 20 minutes. “As long as the chemical is staying in the eye, it’s continuing to burn, and the longer it’s there, the bigger the problem,” said Dr. Cecil J. McCollum, an ophthalmologist and director of emergency services at Callahan Eye Hospital at UAB in Birmingham, Alabama. “Initial irrigation is so important.”

After that, he advises going to an emergency department.

A range of common products can sear eyes, if left within the reach of babies. But parents may not appreciate the full range of products that should be kept in a high cabinet locked away.

“We all think about bleach and toilet cleaner, but what about vinegar, nail polish remover, and even alcohol-based hand sanitizers?” McCollum said, explaining, “They squirt a big blob out, and it splashes into their eye.”

Laundry detergent packets, which can resemble candy, are a relatively new hazard. From 2012 to 2013, at least 17,000 children younger than 6 ingested or squirted the liquid contents into their eyes.

School-age children, 6-14, had some of the lowest rates of chemical eye injuries, as did adults older than 74.

Patients fare differently after chemical eye burns. Sometimes, irritation lasts a few days. More severe burns can lead to decreased visual sharpness, or even blindness. A burned eyelid can contract and permanently droop, exposing its red innards.

Corneas are usually clear, but after a chemical burn, that front layer can scar as it heals. Unfortunately, “that scarring of the cornea can make a person blind in that eye,” said McCollum, who sees one or two such serious cases a month. “It’s not uncommon.”

Alkaline agents found in oven cleaners, drain uncloggers and ammonia products are generally more destructive than acid ones. “Alkaline burns are really bad,” Levin said, because some products can “eat through tissue.”

Unfortunately, what is not defined is which products are “really causing permanent eye injury to children and adults,” Osterhoudt said. If experts knew the culprits and how they end up in people’s eyes, then they could devise safety solutions.

An immediate step is to keep household cleaners up high much like prescription drugs, not under a sink at eye level for little people, Haring said. Cabinet locks might be an effective strategy. Pay special attention to spray bottles of products like bleach and toilet cleaner, always twisting to “off” when not in use, he said.

To Learn More:

Epidemiologic Trends of Chemical Ocular Burns in the United States (by R. Sterling Haring, DO, MPH; Isaac D. Sheffield, BS; Roomasa Channa, MD; Joseph K. Canner, MHS; and Eric B. Schneider, PhD; JAMA Ophthalmology) (abstract)

Greater Concussion Awareness behind Increasing U.S. Kids’ ER Visits for Soccer Injuries (by Lindsey Tanner, Associated Press)

Lives Put at Risk by Manufacturers’ Poor Product Designs (by Lena Groeger, ProPublica)

Congress Reaches Bipartisan Safety Standards Agreement for Dangerous Chemicals (by Matthew Daly, Associated Press)