title: Progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate (0.02%).
abstract: OBJECTIVE
  To report a case of progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate 0.02%.
  
  
  METHODS
  A 45-year-old woman was treated for presumed Acanthamoeba keratitis with chlorhexidine gluconate 0.02% and propamidine 0.1% eyedrops.
  
  
  RESULTS
  After using the chlorhexidine and propamidine eyedrops for 8 weeks, the patient developed a near total loss of the corneal epithelium and a progressive ulcerative keratitis, which eventually required penetrating keratoplasty. Histopathologic examination of the corneal button showed ulceration and loss of Bowman's membrane, massive loss of keratocytes with apparent apoptosis, and loss of the endothelial cells with inflammatory cells adherent to the remaining cells. These histopathologic findings are similar to those seen in Hibiclens keratopathy. Hibiclens contains chlorhexidine 4% with a detergent. No organisms were seen in sections stained with modified Ziehl-Neelsen, gram, Grocott, or periodic acid-Schiff, and immunohistochemistry showed no significant findings.
  
  
  CONCLUSIONS
  We think that the topical use of chlorhexidine gluconate 0.02% may have resulted in a progressive ulcerative keratitis in our patient.
authors.affiliation: Royal Glamorgan Hospital, Llantrisant, United Kingdom CF72 8XR.
authors.forename: Shashidhar
authors.initials: S
authors.lastname: Murthy
authors.forename: Nick R
authors.initials: NR
authors.lastname: Hawksworth
authors.forename: Ian
authors.initials: I
authors.lastname: Cree
mesh_terms: D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D003315:Cornea / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D003320:Corneal Ulcer / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000891:Anti-Infective Agents, Local; D009883:Ophthalmic Solutions; C010882:chlorhexidine gluconate; D002710:Chlorhexidine