Since the onset of the COVID-19 pandemic, there has been an advisory for regular and thorough cleaning of hands besides other measures such as social distancing and self-isolation. The rationale for the same is to prevent the transfer of the virus from hands that have come in contact with fomites. While both alcohol-based hand rubs (ABHR) or washing with soap and water are claimed to have been effective, hand sanitizers have gained more popularity due to the ease of use. The increased frequency of ABHR use and the aerosols generated pose a potential threat to the skin and exposed mucosal surfaces, especially that of the eye due to the proximity of use. The adverse effects of alcohol in these sanitizers can be manifold. An allergic or inflammatory response can occur depending on the predisposing or preexisting conditions. This article describes the risks, underlying mechanisms, and preventive measures for sanitizer aerosol-driven ocular surface disease.

PURPOSE: To analyze corneal and epithelial remodeling differences between SmartSurfACE reverse transepithelial PRK (SCHWIND eye-tech-solutions) and Streamlight (Alcon Laboratories, Inc) transepithelial PRK procedure using optical coherence tomography (OCT) and artificial intelligence (AI). METHODS: This was a prospective, interventional, and longitudinal study. A contralateral eye study was conducted in which one eye was assigned to the SmartSurfACE group and the fellow eye was assigned to the Streamlight group. OCT was performed preoperatively and 1, 3, and 6 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and residual refractive error was measured only preoperatively and at 3 and 6 months. From OCT, curvature and aberrations of the air–epithelium (A–E) interface, epithelium–Bowman's layer (E-B) interface, and epithelium Zernike indices (EZI) were derived. Pain was evaluated at 1 day postoperatively using the Wong-Baker scale. RESULTS: Both groups had similar UDVA, CDVA, residual refractive error, and changes in A–E and E-B curvatures at 3 and 6 months postoperatively ( P > .05). However, many parameters indicated that the Streamlight group underwent a greater change in A–E aberrations, E-B aberrations, and EZI than the SmartSurfACE group postoperatively ( P < .05). The EZI indicated a greater level of epithelial thickness distortion in the Streamlight group than in the SmartSurfACE group ( P < .05). Using AI, the EZI were most indicative of remodeling differences between the two groups. Further, the pain was significantly greater at 1 day in the Streamlight group ( P < .05). CONCLUSIONS: Early remodeling differences existed because the Streamlight procedure removed a greater amount of epithelium than the SmartSurfACE procedure. However, the visual and refractive outcomes were comparable. [ J Refract Surg . 2020;36(10):678–686.]