Soap, shampoo, sunscreen or hand sanitiser in a child's eye: what to do first and when to be seen

Bath time shampoo, a sunscreen smear, a pump of sanitiser at the mall, minyak angin on a stuffy nose and then a rub of the eye. Most end in a few loud minutes and nothing worse. A few do not, and the difference is which product it was and how fast the water went on.

What do I do first when soap or shampoo goes in my child's eye?

Rinse with clean running water straight away, and do not stop to find the bottle. HealthyChildren.org, the American Academy of Pediatrics parent site, lists shampoo, soap, sunscreen, toothpaste, hair spray, deodorant and cosmetics among the household products that are usually harmless, and says to wash the eye out for at least two minutes. It also says not to delay flushing to find the product label.

Take the contact lens out first if an older child wears one. Then keep the water gentle. The NHS says to use clean water that is not hot, from the tap, the shower or a bottle, to hold the eye open and to keep the flow "not too strong". Do not let the child rub. The NHS says not to touch or rub the eye until it is better, and rubbing is the first thing every toddler does.

Two minutes is the floor for these everyday products, not a target to stop at. The NHS figure for an eye injury is at least 20 minutes. If the child is still crying and squeezing at the two-minute mark, keep the water going rather than stop and watch.

How do I rinse the eye of a toddler who will not keep it open?

Lay the child down and pour, rather than try to hold a small head under a tap. HealthyChildren.org suggests that a younger child lies down while you slowly pour warm tap water into the eye from a pitcher or glass, holding the lid open if needed, with a folded towel under the head. A bathtub works well. An older child can put the whole face into a basin of water and blink, look from side to side, and have the water changed several times.

Two adults make this easier. One holds the child, calm and close. The other pours and keeps the lids apart with clean fingers. A child in pain will clamp the lids shut, and water that runs over a closed lid is doing very little. A calm voice works better than force. If the child is too distressed for one long rinse, do several short ones and add up the minutes on a phone timer.

What should I not put in the eye afterwards?

Nothing except clean water or saline. That means no breast milk, milk, salt water, herbal remedy, oil, or the eye drops from the cupboard.

None of the guidance cited here recommends milk or breast milk for the eye, and none of it tests it. It all says water. For eye drops, HealthyChildren.org gives a specific warning: do not use redness-relieving (vasoconstrictor) drops, because "they hide redness", and redness that lasts more than 24 hours needs to be seen.

A drop that hides the sign you are watching for makes the next decision harder. Drops that were prescribed for someone else, or for this child on another day, were chosen for a different eye. Eye drops in the house goes through what is safe to keep and why.

If the label of the product gives advice, follow it as well as the water. The NHS says that for cosmetics and household products, you can follow the advice on the packaging.

Is alcohol hand sanitiser worse than soap in a child's eye?

It can be. HealthyChildren.org lists rubbing alcohol, including hand sanitiser, as usually harmless but able to burn the cornea, the clear front window of the eye. It says to wash it out briefly, and to go to the emergency department if symptoms remain.

The clearest evidence comes from France in 2020. A report in JAMA Ophthalmology looked at poison centre calls for children under 18 who had a chemical splashed in the eye. Calls about alcohol-based hand sanitiser rose from 33 in the spring and summer of 2019 to 232 in the same months of 2020, while calls about other chemicals fell. Nearly all were mild.

But at one Paris children's eye emergency service, 16 children came in with sanitiser in the eye in 2020. Eight had an ulcer of the cornea or the conjunctiva (the thin skin over the white of the eye), six of them covering more than half the cornea. Two needed an operation under general anaesthetic to place a membrane over the surface, and the eyes that healed took a median of 13 days to do so.

Two details from that report matter to a parent. First, many of the exposures were from wall-mounted dispensers at about one metre, "at the level of small children's eyes", and the authors noted a delay in washing because there was no water nearby. Second, the authors' figure shows that pain can be gone two days after the exposure and a red eye may be the only sign left.

So a child who cried hard, settled and has a red eye the next morning should be checked, not assumed fine. This is a French series from one country, and most of the children did well. It does not say that every splash of sanitiser burns.

What about minyak angin, minyak kayu putih and minyak telon in the eye?

Treat them as oils that need a long rinse with water, and have the eye looked at if it still hurts. The guidance cited here does not test these Malaysian products one by one, so this rule is borrowed from advice on essential oils.

The nearest source is the Western Australia health department guidance on essential oils, which says to rinse the eye straight away under running water, from the corner by the nose outward, for 15 minutes, and that persistent eye symptoms should be seen by a doctor. The same page says children are particularly susceptible and that oils should be kept in a child-resistant container, out of reach.

Oil on the chest or temples moves to the fingers and then the eye, so wash the child's hands as well as the eye. If a child has also swallowed any, that is a different problem: the Malaysian National Poison Centre (Pusat Racun Negara) takes calls on +604 6536 999, with hours listed on its site as 8am to 10pm on weekdays and 8am to 5pm at weekends and on public holidays.

When does my child need an eye doctor today?

Go the same day if the pain does not settle after rinsing, if the child will not open the eye, if sight is blurred, or if there is a white or cloudy patch on the eye.

HealthyChildren.org says to call the doctor now if tearing, blurred vision or eye pain lasts more than an hour after flushing. The NHS says to get urgent help if the eye is very painful, if there is any change to sight after an injury, or if you are worried, particularly when it is a child.

• The eye still hurts or waters after a good rinse, or the child keeps it shut.
• The child blinks away from light, or says things look blurry.
• There is a white, grey or cloudy patch on the clear part of the eye.
• The product was alcohol sanitiser and the eye is red the next day, even if the pain has gone.
• The product was a strong one. HealthyChildren.org says acids and alkalis, such as drain, oven and bathroom cleaners, need a 20 minute flush and then the emergency department, and the NHS says the same for bleach and oven cleaner. Keep rinsing on the way, and take the container.

Household bleach and laundry or dishwasher detergent capsules sit in between, and HealthyChildren.org says to flush for 10 minutes and then call the poison centre, who can say whether the child needs to be seen. For anything stronger than a soap, the first sixty seconds after a chemical splash is the page to open. If the product was food, chilli and hot oil has its own page, and for adhesives, glue in the eye has the opposite rule for stuck lids.

If you are unsure whether a sign counts, the urgent guide lists the signs by how soon they need a doctor, and when an eye that hurts needs a visit today covers pain more broadly.

When is stinging that settles enough?

If the product was one of the everyday ones, the rinse went on quickly, and within about an hour the eye is open, comfortable and not blurred, HealthyChildren.org says self-care is reasonable. A little pink around the eye can follow a rinse. The same page says to contact the doctor within 24 hours if redness is still there after 24 hours.

That rule asks you to watch, not to relax completely. Look again that evening and the next morning. A child who goes quiet, rubs the eye again or turns away from a lamp needs a check.

How do I stop it happening again?

Move the products, then wash the hands. Keep sanitiser bottles up high, because the French report points to dispensers at the height of a small child's eyes. Keep medicated oils in a child-resistant container out of reach, as the Western Australia page advises. For the rest of the cupboard, eye safety at home walks through the shelves.

Common questions

References

1. NHS · Eye injuries · www.nhs.uk (opens in a new tab)
2. HealthyChildren.org (American Academy of Pediatrics) · Eye: chemical in · www.healthychildren.org (opens in a new tab)
3. Martin et al. · Pediatric eye injuries by hydroalcoholic gel in the context of the COVID-19 pandemic, JAMA Ophthalmology 2021 · jamanetwork.com (opens in a new tab)
4. Healthy WA (Western Australia Department of Health) · Essential oils · www.healthywa.wa.gov.au (opens in a new tab)
5. Pusat Racun Negara (National Poison Centre of Malaysia), Universiti Sains Malaysia · prn.usm.my (opens in a new tab)

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.