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Severe alkali burns from beer line cleaners warrant mandatory safety guidelines

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To the Editor: Two patients at our tertiary referral eye hospital had received severe alkali burns to the face and eyes while cleaning beer lines. In hotels, pubs and clubs, beer lines are cleaned weekly using strong alkaline solutions at high pressure. In an accident, alkali released under high pressure can produce blinding damage.

Our patients were young, typical of workers at these venues, and their injuries have had major impacts on their lives. One incident involved the face (60%–80% of facial skin) and both eyes (grade IV1) of a 23-year-old man (Box) using a commercially available beer line cleaner (potassium hydroxide; pH, 14). His eyes were immediately irrigated with water. His initial visual acuity was hand movements in the right eye and light perception in the left eye. He had bilateral corneal opacification and ocular ischaemia with hypotony in the left eye. He was treated according to burns protocol,1 but a non-healing right corneal ulcer developed, requiring multiple operations. Bilateral reconstructive eyelid surgery was also needed.2 His vision is currently light perception and no light perception with hypotony, respectively, in his right and left eyes. He requires further surgery to preserve his remaining vision, as well as ongoing psychological and social support.