Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis—Reply

Abstract

ment and a methylprednisolone tapered dose pack. At 1-month follow-up, she had no pain, evidence of infection, or motility disturbance.Many household and store devices pose unintended ocular and periorbital damage risks. One report describes ocular trauma from merchandise display hooks, bringing awareness of this danger to shoppers and advocating modifying display hook design. 2 Cakes with wooden dowels pose a similar potentially underrecognized danger to the uninformed public. The hidden dowels, intended to provide stability to a multilayer cake, represent possible hazards especially in the setting of pranks or cultural traditions, such as in this patient. One similar anecdotal report was shared on social media, in which a woman sustained a periorbital injury when her face was pushed into a cake with a wooden dowel as a prank. 3 Additionally, a Mexican birthday tradition is la mordida, in which the guest of honor's face is shoved into their cake for the first bite for good luck. 4 While this tradition is intended to occur humorously and festively, there is inherent risk for ocular or orbital injury from hidden dowels, including retained intraorbital wooden foreign body that may be a nidus for infection. 5,6 Orbital computed tomography should be performed in periocular trauma to assess for these intraorbital foreign bodies and the extent of the injury. 1,5 Fortunately, this patient did not sustain severe ocular or orbital injury, as vital structures were missed due to the direction of the dowel penetration.To our knowledge, this case is the first in the medical literature to document and raise awareness of this hazard. We propose that the bakery industry consider warning labels for cakes with wooden dowels, as there are no regulations or requirements to provide this information to consumers. Additionally, we recommend celebrants of la mordida eliminate wooden dowels from cake assemblies or avoid forcefully planting the face on the cake. We hope knowledge of this hazard will modify consumer behavior to prevent ocular and orbital injury.