PostScript Occup Environ Med: first published as 10.1136/oemed-2020-106677 on 28 May 2020. Downloaded from Letter were negative. The nurses were advised to Since this intervention, no further cases continue working. One month later, their have occurred. had almost completely healed. 1 2 Cluster of chalazia in nurses Interestingly, the depart- Bruno Mégarbane ‍ ‍ , Ramin Tadayoni using eye protection while ment of our hospital has noticed about 10 1Department of Medical and Toxicological Critical Care, caring for critically ill patients additional cases consulting for Lariboisière Hospital, Federation of Toxicology APHP, during March 2020, mainly among nurses University of Paris, INSERM UMRS-1144, Paris, France with COVID-19 in 2Department of Ophtalmology, Lariboisière Hospital, working in the hospital. University of Paris, Paris, France intensive care Chalazion usually occurs from inflam- mation and obstruction of the sebaceous Correspondence to Dr Bruno Mégarbane, Department of Medical and Toxicological Critical Care, The world is facing a frightening pandemic glands of the eyelids, that is, a tarsal Lariboisière Hospital, Federation of Toxicology APHP, caused by the severe acute respiratory Meibomian gland (deep chalazion) or, University of Paris, INSERM UMRS-1144, Paris, France; syndrome coronavirus 2 (SARS-CoV­ -2) less frequently, a Zeis gland (superficial bruno.​ ​megarbane@lrb.​ ​aphp.fr​ 4 with thousands of infections and fatali- chalazion). Mask wearing could be one Contributors BM and RT wrote the letter and BM is ties. After 15 days of hard working in the explanation for the chalazion because it the corresponding author. intensive care unit managing patients with may direct the breath towards the . Funding The authors have not declared a specific COVID-19, three nurses simultaneously However, our nurses wore hermetically grant for this research from any funding agency in the public, commercial or not-­for-­profit sectors. complained about a with painless sealed protective glasses disinfected for eyelid swelling and tearing. Ophthalmo- 15 min in a bath made of 0.5% dide- Competing interests None declared. logical examination revealed similar single cyldimethylammonium chloride and Patient consent for publication Obtained. non-­tender inflammatory nodules located chlorhexidine digluconate (Clean Excel D, Ethics approval A written consent and permission in the middle of the lower eyelid, accom- Anios, France) diluted in water as recom- were obtained from the patient to include her case panied by conjunctival redness without mended by the manufacturer. Eyelid details and image in the case report. altered visual acuity or corneal abrasion irritation and dehydration is a likely expla- Provenance and peer review Not commissioned; (figure 1). Chalazion was diagnosed. nation for the chalazion generation. Gland internally peer reviewed. Combined topical antibiotic and anti-­ oil may have hardened due to the gener- This article is made freely available for use in inflammatory (dexamethasone–oxytet- ated warmth and limited gland drainage accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until racycline) eye ointment was prescribed caused by reduced reflex eyelid blinking and spontaneous hand rubbing on the otherwise determined by BMJ. You may use, download with recommendations to apply a warm and print the article for any lawful, non-­commercial compress to the affected eye with lid face. Insufficient rinsing in water before purpose (including text and data mining) provided that massaging to facilitate healing. the reuse of the glasses due to the small all copyright notices and trade marks are retained. First, we ruled out COVID-19 in each size of the available rinsing boxes at the © Author(s) (or their employer(s)) 2020. No commercial nurse, as ocular manifestations have been bedside and to the rush while managing re-­use. See rights and permissions. Published by BMJ. observed, although mostly during the critically ill patients with COVID-19 care middle phase of the disease and in patients clearly contributed. with severe pneumonia.1 Conjunctival Exposure to quaternary ammonium (such as didecyldimethylammonium chloride) To cite Mégarbane B, Tadayoni R. Occup Environ Med hyperaemia, epiphora and chemosis Epub ahead of print: [please include Day Month Year]. have been described, while more severe and biguanide (such as chlorhexidine diglu- doi:10.1136/oemed-2020-106677 http://oem.bmj.com/ features were only reported in animal conate) antiseptic agents in the workplace is 5 Received 8 May 2020 models.2 Interestingly, unilateral conjunc- usually due to inhalation or skin contact. Revised 12 May 2020 tivitis has been reported in one case as the Toxicity results from irritation and corro- Accepted 24 May 2020 first manifestation of COVID-19.3 Here, sion of the skin and mucous membranes Occup Environ Med 2020;0:1–2. laboratory SARS-CoV­ -2 reverse transcrip- with eye and lung damage. Although not doi:10.1136/oemed-2020-106677 included in the list of occupational expo- tion–PCR tests performed on throat swabs ORCID iD

sure risks, the cluster of chalazion may have on October 4, 2021 by guest. Protected copyright. Bruno Mégarbane http://orcid.​ ​org/0000-​ ​0002-2522-​ ​ emerged due to the particular conditions 2764 of the disinfection of the protective glasses and their wearing during the COVID-19 References pandemic. Interestingly, a temporal asso- 1 Wu P, Duan F, Luo C, et al. Characteristics of ocular ciation was reported in the USA between findings of patients with coronavirus disease 2019 the increase in toxic exposures to cleaners (COVID-19) in Hubei Province, China. JAMA Ophthalmol and disinfectants in January–March 2020 2020;138:575. 2 Seah I, Agrawal R. Can the coronavirus disease 2019 (+20%) and their expanded use due (COVID-19) affect the eyes? A review of coronaviruses 6 to SARS-CoV­ -2 epidemic. Exposures and ocular implications in humans and animals. Ocul included chemical eye exposures in relation Immunol Inflamm 2020;28:391–5. to the improper use of disinfectants, which 3 Daruich A, Martin D, Bremond-­Gignac D. Ocular could be prevented by wearing adequate manifestation as first sign of coronavirus disease 2019 (COVID-19): interest of telemedicine during the eye protection. pandemic context. J Fr Ophtalmol 2020;43:389–91. In our hospital, recommendations to 4 Jordan GA, Chalazion BK. StatPearls [Internet]. Treasure Figure 1 Chalazion of the lower eyelid in a improve rinsing of the disinfected glasses Island, FL: StatPearls Publishing, 2020. http://www.​ncbi.​ nurse working with patients with COVID-19 and the method of wearing them were nlm.nih.​ ​gov/books/​ ​NBK499889/ 5 Bello A, Quinn MM, Perry MJ, et al. Characterization wearing protective glasses disinfected with a provided to the nurses by the hygienist of occupational exposures to cleaning products used solution of didecyldimethylammonium chloride on the day following the notification of for common cleaning tasks--a pilot study of hospital and chlorhexidine digluconate. our three cases to occupational medicine. cleaners. Environ Health 2009;8:11.

Occup Environ Med Month 2020 Vol 0 No 0 1 PostScript Occup Environ Med: first published as 10.1136/oemed-2020-106677 on 28 May 2020. Downloaded from 6 Chang A, Schnall AH, Law R, et al. Cleaning and Associations with COVID-19 - National Poison 31, 2020. MMWR Morb Mortal Wkly Rep Disinfectant Chemical Exposures and Temporal Data System, United States, January 1, 2020-­March 2020;69:496–8. http://oem.bmj.com/ on October 4, 2021 by guest. Protected copyright.

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