title: Deleterious effects of swimming pool chlorine on the corneal epithelium.
abstract: OBJECTIVE
  To study the effect of rinsing with tap and pool water on the ocular surface epithelium.
  
  
  METHODS
  Twenty eyes of 10 volunteers were irrigated in the following order with 250 mL (50 seconds) of physiological salt solution (PSS), distilled water (DW), tap water, or PSS with chlorine (0.5 mg/L). The pH of each fluid was 6.4, 6.8, 6.8, and 6.4, respectively. Vital staining, fluorophotometric assessment, and confocal microscopy were performed before and after irrigation with each fluid.
  
  
  RESULTS
  Eyes irrigated with PSS with chlorine showed an increase in fluorescein scores, and eyes washed with both tap water and PSS with chlorine showed an increase in Rose Bengal scores. Corneal fluorescein uptake measured by anterior fluorometer was not altered by eye irrigation with PSS, DW, or tap water. However, PSS with chlorine resulted in a significant increase in corneal fluorescein uptake. Confocal microscopy showed corneal epithelial cell damage in eyes rinsed with PSS with chlorine.
  
  
  CONCLUSIONS
  Chlorine was determined to be potentially harmful to the corneal epithelial barrier. This study indicated the possibility that swimming without goggles might become a risk factor for corneal epithelial integrity, suggesting encouragement of goggle wear while swimming.
authors.affiliation: Ryogoku Eye Clinic, Tokyo, Japan. misaki@misaki-eye.com
authors.forename: Misaki
authors.initials: M
authors.lastname: Ishioka
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Akira
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Murat
authors.initials: M
authors.lastname: Dogru
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000328:Adult; D002463:Cell Membrane Permeability / Q000187:drug effects; D002713:Chlorine / Q000009:adverse effects*; D003316:Corneal Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D004202:Disinfectants / Q000009:adverse effects*; D019573:Epithelium, Corneal / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D005260:Female; D019793:Fluorescein / Q000378:metabolism; D015590:Fluorophotometry; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007365:Intercellular Junctions / Q000187:drug effects; D008297:Male; D018613:Microscopy, Confocal; D012965:Sodium Chloride / Q000008:administration & dosage; D013551:Swimming Pools; D014867:Water / Q000737:chemistry
chemical_list: D004202:Disinfectants; D014867:Water; D012965:Sodium Chloride; D002713:Chlorine; D019793:Fluorescein