title: Chlorhexidine Keratitis: Safety of Chlorhexidine as a Facial Antiseptic.
abstract: BACKGROUND
  Effective antiseptic to reduce surgical site infections is a cornerstone of modern surgery. Chlorhexidine gluconate-based antiseptics are among the most effective of these products. Unfortunately, chlorhexidine solutions are toxic to the cornea and middle ear, and they pose a splash risk to both the patient and health care personnel.
  
  
  OBJECTIVE
  To examine the clinical evidence that led to the disavowal of chlorhexidine antiseptic solution for use on the face and head.
  
  
  METHODS
  Reference searches were performed using PubMed, Embase, and LexisNexis databases without restriction to the date of publication, language, or study setting.
  
  
  RESULTS
  The literature revealed 11 sentinel cases of severe chlorhexidine-related keratitis in the late 1980s. These cases are reviewed together with data on ototoxicity and alternative products to understand why chlorhexidine solution should not be used on the face and scalp.
  
  
  CONCLUSIONS
  Chlorhexidine antiseptic solutions are highly effective. However, they pose a risk to the middle ear and have the potential to irreversibly damage the cornea with a minimal splash exposure. Povidone-iodine is a safe and effective alternative.
authors.affiliation: *Division of Ophthalmic Plastic and Reconstructive Surgery, Jules Stein Eye Institute, David Geffen School of Medicine, Los Angeles, California; †Associate Professor of Ophthalmology and Dermatology, Chief Oculofacial Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Steinsapir
authors.forename: Julie A
authors.initials: JA
authors.lastname: Woodward
mesh_terms: D000279:Administration, Cutaneous; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000009:adverse effects*; D057915:Drug Substitution; D005145:Face; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced; D006801:Humans; D007634:Keratitis / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects*; D012535:Scalp
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine