Continuous Corneal Endothelial Damage by Chlorhexidine Alcohol Used for Disinfection in Nonophthalmic Surgery

Abstract

Purpose: To report a case of corneal endothelial damage caused by alcohol-containing chlorhexidine gluconate (CG-A) and its progression over time. Methods: This was a case report. Results: A 22-year-old man underwent neurosurgery under general anesthesia. CG-A (1%) was used for disinfection after the application of corneal protection tape. Postoperatively, the patient presented with hyperemia and swelling of the left conjunctiva and was referred to our department. Initial examination revealed left corneal epithelial erosion and corneal edema, which improved on postoperative day 14. The corneal endothelial cell density (ECD) was 3,345 cells/mm2 on day 14, decreased rapidly to 2,090 cells/mm2 on day 42, and slowly reduced to 1,122 cells/mm2 on day 168. Thereafter, no decrease in ECD was observed. Conclusions: CG formulations can lead to a persistent decrease in ECD over several months, even after improvement of acute corneal edema.