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Worried about long-term eye injury

Last summer, one of my patients was exposed to tear gas during a demonstration. Among other signs and symptoms, she experienced burning pain in her eyes during the incident. Although her ocular symptoms subsequently resolved, she's worried about possible long-term problems. Is she right to be concerned?-S.R., ORE.


Although commonly called "tear gas," riot control agents are chemical compounds designed to temporarily disable people by irritating the eyes, mouth, throat, lungs, and skin. Released into the air as liquids or fine particles, they cause extreme tissue irritation within a few seconds of exposure. However, the effects generally resolve in 15 to 30 minutes after the person has been removed from the exposure area and decontaminated.1


According to the CDC, prolonged exposure, especially in an enclosed area, may lead to long-term complications, including ocular problems such as glaucoma and cataracts. However, the CDC states that long-term complications are unlikely if symptoms resolve soon after the exposure.


If your patient continues to be concerned or is experiencing vision problems, advise her to consult an eye care provider.



1. Centers for Disease Control and Prevention. Facts about riot control agents interim document. 2018. [Context Link]



Saving face with repurposed dressings

Because I care for patients with COVID-19, I constantly wear personal protective equipment (PPE), including N95 masks that are starting to irritate my face. What can I do to protect my skin without disrupting the mask's snug fit?-N.S., N.C.


Encountering the same problem early this year, nurses at a hospital in the Kingdom of Bahrain investigated whether a repurposed silicone-based dressing applied beneath an N95 mask could protect facial skin without compromising the mask's tight seal.1 The hospital's Pressure Injury Prevention Committee created a stepwise process that involved cutting readily available atraumatic silicone border dressings into strips and applying them over bony facial prominences, such as the bridge of the nose and cheekbones. Ten staff volunteers wore the protective strips under their N95 masks for 4-hour test periods over 2 consecutive days.


Oxygen saturation values taken before and after the 4-hour test period showed that properly fitted protective strips did not compromise mask seal-in fact, they may have even improved the fit by increasing the mask's seal stability. The volunteers reported increased comfort with less friction.


The authors recommend adding an atraumatic silicone border dressing "as a safe and beneficial option to protect facial skin under PPE." For details about the study, including photos showing how the skin protection strips were created and applied, visit



1. Smart H, Opinion FB, Darwich I, Elnawasany MA, Kodange C. Preventing facial pressure injury for health care providers adhering to COVID-19 personal protective equipment requirements. Adv Skin Wound Care. [e-pub June 11, 2020] [Context Link]



Even occasional use is significantly harmful

One of my patients, now 48, has smoked cigarettes daily since she was 16. She says she is cutting back to a few cigarettes per month but doesn't want to stop entirely because she believes the health consequences from an occasional cigarette are minimal. Does the evidence support this?-L.A., COLO.


Based on a recent study involving data on 505,500 US adults, no. A prospective cohort study was designed to investigate the association of reducing cigarette smoking from daily to nondaily use with mortality risks.1 Cigarette smokers were classified as daily or nondaily users; current nondaily smokers were further categorized by whether they had previously smoked every day.


The study showed that compared with never smokers, the mortality risk for daily smokers was 2.32 times higher; for lifelong nondaily smokers, the mortality risk was 1.82 times higher. Significant associations were found for 6 to 10 cigarettes per month and increased with higher-intensity use.


"Risks decreased when smokers reduced from daily to nondaily smoking, yet the benefits of cessation were far larger," the authors write. "Nondaily smokers have substantially higher mortality risks than never smokers, even if they smoke just a few cigarettes per month." Discuss the evidence with your patient and continue to encourage her to stop smoking entirely.



1. Inoue-Choi M, Christensen CH, Rostron BL, et al Dose-response association of low-intensity and nondaily smoking with mortality in the United States. JAMA Netw Open. 2020;3(6):e206436. [Context Link]



Keep a lid on it

One of my patients is recovering from COVID-19. Her signs and symptoms were primarily gastrointestinal, such as diarrhea and abdominal pain. This made me wonder, is the oral-fecal route a likely route of transmission?-L.W., OKLA.


The coronavirus that causes COVID-19 (severe acute respiratory syndrome coronavirus 2) can survive in the gastrointestinal tract, but how readily it can be transmitted via the oral-fecal route is unclear. However, viral RNA has been isolated from the feces of at least one infected patient, so transmission via this route is considered theoretically possible.1


Given this potential risk, a recent simulation study of fluid dynamics suggests a new hazard.2 Researchers have demonstrated that flushing the toilet ejects a cloud of aerosolized fecal particles into the air. "The simulation results are alarming in that massive upward transport of virus particles is observed, with 40% to 60% of particles reaching above the toilet seat, leading to large-scale virus spread," the authors write. "Toilets are a daily necessity but also become dangerous if used improperly, especially against the current scenario of a global pandemic."


To reduce risk of transmitting viruses and other pathogens found in fecal matter, the authors recommend:


* cleaning the toilet seat before use to eliminate any particles that may have settled there after the last flush.


* lowering the toilet lid before flushing.


* washing the hands immediately after flushing the toilet, keeping in mind that fecal particles flushed into the air may have settled on the toilet handle and other nearby surfaces.



Reinforce the importance of these basic hygienic practices with all your patients.



1. Xiao F, Sun J, Xu Y, et al Infectious SARS-CoV-2 in feces of patient with severe COVID-19. Emerg Infect Dis. 2020;26(8):1920-1922. [Context Link]


2. Li Y, Wang J, Chen X. Can a toilet promote virus transmission? From a fluid dynamics perspective. Phys Fluids. 2020;32(6):065107. [Context Link]