title: Corneal Injury from Presurgical Chlorhexidine Skin Preparation.
abstract: BACKGROUND
  Chlorhexidine skin preparation has been shown to provide highly effective antimicrobial presurgical skin cleansing. However, there is a significant risk of ocular toxicity when it is used in periocular areas.
  
  
  METHODS
  We describe 2 cases of significant corneal damage resulting from 4% chlorhexidine gluconate preoperative skin cleanser, despite the use of protective occlusive dressing over the eyes. Because of the potential for severe corneal toxicity resulting from use of chlorhexidine, alternative agents such as 10% povidone-iodine should be considered for skin preparation near periocular areas whenever possible.
  
  
  CONCLUSIONS
  If chlorhexidine gluconate must be employed near periocular areas, great care must be exercised to avoid contact with the eyes, and additional protective measures (e.g., absorbent eye pads along with tightly occlusive dressings) must be used whenever possible.
authors.affiliation: Department of Ophthalmology and Cornea Service, University of California San Francisco, San Francisco, California, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Bever
authors.affiliation: Department of Ophthalmology and Cornea Service, University of California San Francisco, San Francisco, California, USA.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Brodie
authors.affiliation: Department of Ophthalmology and Cornea Service, University of California San Francisco, San Francisco, California, USA. Electronic address: david.hwang@ucsf.edu.
authors.forename: David G
authors.initials: DG
authors.lastname: Hwang
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000633:toxicity; D003315:Cornea / Q000187:drug effects; D065306:Corneal Injuries / Q000139:chemically induced* / Q000517:prevention & control; D016510:Corneal Neovascularization / Q000139:chemically induced; D003319:Corneal Stroma / Q000187:drug effects; D003399:Craniotomy; D004202:Disinfectants / Q000633:toxicity*; D004728:Endothelium, Corneal / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D049670:History, 17th Century; D006801:Humans; D007796:Laminectomy; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D009779:Occlusive Dressings; D017397:Prefrontal Cortex / Q000187:drug effects* / Q000601:surgery*; D011300:Preoperative Care; D013123:Spinal Fusion
chemical_list: D004202:Disinfectants; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: Chlorhexidine; Corneal toxicity; Surgical scrub