Toxic keratopathy due to the accidental use of chlorhexidine, cetrimide and cialit.
Due to economical reasons some ophthalmologists are using an irrigating solution made by the hospital pharmacy instead of the commercially available solutions. These irrigating solutions come in bottles which are identical to the ones used for other solutions. During the last three years bottles were accidentally mixed up five times. Consequently, bottles containing solutions such as chlorhexidine, cetrimide, chlorhexidine/centrimide and cialit solutions were used during cataract surgery. This resulted in immediate corneal edema which, in its turn resulted in a bullous keratopathy. Four patients underwent a penetrating keratoplasty. In one patient the cornea was covered with a conjunctival flap. Light microscopy of the corneas included epithelial edema, loss of keratocytes, and a disrupted and sometimes absent endothelial cell layer.
Department of Ophthalmology, University of Groningen, The Netherlands.
G
G
van Rij
W H
WH
Beekhuis
C A
CA
Eggink
A J
AJ
Geerards
L
L
Remeijer
E L
EL
Pels
D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D002387:Cataract Extraction; D000077286:Cetrimonium; D002593:Cetrimonium Compounds / Q000009:adverse effects*; D002710:Chlorhexidine / Q000009:adverse effects*; D002920:Cialit / Q000009:adverse effects*; D003315:Cornea / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D003316:Corneal Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D015715:Corneal Edema / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating; D008297:Male; D009883:Ophthalmic Solutions; D007507:Therapeutic Irrigation
D000891:Anti-Infective Agents, Local; D002593:Cetrimonium Compounds; D009883:Ophthalmic Solutions; D002920:Cialit; D002710:Chlorhexidine; D000077286:Cetrimonium