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Tips to Avoid the Emergency Room this Halloween for an Eye or ENT Problem

Halloween can be one of the most fun days of the year. What’s not to love between the costumes, candy and parties? A trip to the emergency department, however, can put a damper on the celebration.

Some of the things that make Halloween so enjoyable unfortunately pose unique risks to the eyes, face, ears, nose and throat. Therefore, it’s important that children and their parents practice vigilance to enjoy an accident-free Halloween.

Mass Eye and Ear doctors Neal Patel, MD, director of the Ophthalmology Trauma Service, and Robin Pappal, MD, a comprehensive ear, nose and throat (ENT) surgeon, offered the Focus blog a few tips on how to best avoid a trip to the Mass Eye and Ear Emergency Department this Halloween.

Eye safety concerns from costumes

Many of the eye risks children face each Halloween involve costumes, according to Dr. Patel. While some costume props and makeup pose direct injury risks to the eye, simply wearing a costume can be concerning if it obstructs vision, he said.

“The biggest thing we’re worried about is a child not being able to see well when they’re out trick-or-treating,” said Dr. Patel. “If a costume obstructs vision, children are at a higher risk of running into the street and being hit by a car they didn’t see or tripping and falling.”


This is something children and parents should be especially mindful of considering that a lot of trick-or-treating is done after dark. Families should be extra careful when considering costumes with masks, eye patches, wigs or anything else that can obstruct vision.

Another significant eye risk comes from decorative contact lenses, which some teens and adults sport to achieve their perfect Halloween look. Several studies show these contact lenses can cause bad infections because they become easily colonized by bacteria, Dr. Patel pointed out. The bacteria gets trapped under the contact lens and can cause infections like corneal ulcers.

In fact, the U.S. Food and Drug Administration warns about the risks associated with decorative contact lenses each year.

“Decorative colored contact lenses are typically less breathable than regular lenses and therefore make an infection more likely,” said Dr. Patel. “If you really want colored contact lenses, consult an optometrist who can get a prescription for a safer pair.”

Another common eye problem seen by doctors each Halloween are injuries caused by costume props, such as pointy swords. Children should be extra careful and avoid hitting their eye or someone else’s, otherwise they risk getting a corneal abrasion (scratch) that can be very painful and affect vision.

Lastly, face paints and makeup can be irritating to the eye and surrounding area. If a child does get face paint in their eye, it’s important to flush it immediately with water. If the eye still hurts, it might be worth visiting the emergency department, said Dr. Patel. Simply applying face paint and make-up can also cause some risks if applied around the eye, namely an allergic reaction.

“The area around the eye and eyelid are more sensitive to allergic reactions than skin in other areas of the body,” said Dr. Patel. “I would avoid putting face paint near the eye or on the delicate eyelid skin and would recommend hypoallergenic brands.”

Common ear, nose and throat hazards at Halloween

According to Dr. Pappal, children between the ages of two-to-five are most susceptible to ENT-related incidents from small objects on Halloween. These incidents include choking on tiny pieces of candy, or trying to stick small pieces of a costume up the nose or ears. While gum, hard candies, gummies, whole nuts and popcorn are usual culprits, Dr. Pappal warned that some of the most unassuming objects can pose a hazard. Some years, children have arrived in emergency rooms with a temporary tattoo or a candy wrapper stuck somewhere in their head.

“Young children will put anything they can get a hold of in their ears, nose or mouths,” she said. “Anything bright and colorful at Halloween might seem candy-like, especially to children who don’t know any better.”

halloween-candy-resize-500x375-7431827Objects stuck in the ears and nose carry their own unique risks. While sticking objects too deep into the ear can rupture the eardrum, sticking anything up the nose can cause an infection if left there too long. If pushed too deep inside the nasal cavity, the object might slip into the airway, becoming a foreign body that a child could choke on.

Dr. Pappal noted that the body’s natural response for clearing an airway obstruction is to cough up the blockage. In movies and television, the Heimlich maneuver is often glorified as a life-saving technique; however, the method can be dangerous and should only be used sparingly if the blockage is stuck deep in the airway and a person cannot breathe, speak or cough. By replicating the force of a cough, the maneuver dislodges an obstruction stuck in the throat. This requires a sudden blow to the abdomen, which could inadvertently damage the diaphragm—the muscle responsible for inhaling air into the lungs—or fracture ribs if not administered carefully enough in children.

“Sweeping” is another risky technique parents might attempt on a choking child. Parents might look inside their child’s mouth to see if the obstruction is in plain sight and try to dislodge it by sweeping the inside of the mouth with a finger. While sweeping can clear the airway of any visible objects, Dr. Pappal offered a rule of thumb to prevent the method from worsening the issue:

“Never sweep if you cannot see the object,” Dr. Pappal said. “You might inadvertently push whatever is stuck further down the airway.”

What to do in an emergency

Unfortunately, accidents will happen, and it’s important to know what to do in case of an emergency. If a child is choking on a piece of candy or has an object stuck too far up their nose or ear, parents and guardians should seek immediate care. LED, button batteries and light-up toys pose a significantly higher threat; acid leaks from these objects could corrode internal organs.

emergency-room-stock-resize-500x331-8886287If an object stuck in the nose has not yet entered the airway, children able to blow their nose should do so without inhaling too quickly. For children not old enough to blow their nose, parents can perform a “Mother’s Kiss,” a maneuver in which the parent covers one nostril with their finger and blows a puff of air into the child’s mouth. The puff of air should dislodge the obstruction without pushing it deeper into the airway.

Finally, if the Heimlich maneuver is needed, parents should stick to the fundamentals. According to Dr. Pappal, this means standing behind the child and wrapping both arms around the child’s waist. With one hand, a fist should be held against the child’s belly button while the other hand delivers a quick, upward thrust into the child’s stomach. For smaller children, parents and guardians should kneel behind the child instead of standing. Infants should be laid across a parent’s forearm—with their head supported yet lower than the rest of their body—and gently thumped on the middle of their back.

If a child or parent – let’s not forget parents are also celebrating Halloween – requires a trip to the emergency room for an eye or ENT-related condition, Mass Eye and Ear offers 24/7 care seven days a week in its Emergency Department. The doctors and nurses working there focus exclusively on treating conditions of the eye, ear, nose, throat, head and neck, and have all the specialized equipment needed for such care. The Mass Eye and Ear Emergency Department is the only one of its kind in the New England area.

“Most hospitals don’t have an eye doctor or ENT in the emergency room and the ones on call might not be able to get to a patient right away,” Dr. Patel pointed out. “The Emergency Department at Mass Eye and Ear is sometimes the fastest and only way to see an eye doctor or ENT immediately.”

About the experts

neal-patel-headshot-7079088Neal Patel, MD, is chief resident in the Department of Ophthalmology and director of the Mass Eye and Ear Eye Trauma Service. He treats patients at the Mass Eye and Ear Emergency Department on the Main Campus in Boston.



Robin Pappal, MDrobin-pappal-md-headshot-2023706, is a comprehensive ear, nose and throat (ENT) surgeon who treats children and adults. Her primary clinical focus is on the full spectrum of general adult and pediatric ENT care with particular interests in otology, rhinology and access to equitable healthcare. Dr. Pappal sees patients at the Weymouth and Duxbury suburban centers.

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