Chemical Corneal Burn after Short Exposure to Alcohol-Containing Chlorhexidine Antiseptic

Chlorhexidine is used routinely for asepsis in craniofacial surgeries. A solution containing a lower concentration of chlorhexidine diluted with alcohol has been developed to decrease chlorhexidine-related side effects. Herein, we report a case of chemical corneal burn caused by hexitanol solution (2% chlorhexidine + 72% ethanol) in a patient after undergoing closed reduction for nasal fracture under general anesthesia. Although the presumptive exposure time of the cornea was short, slit-lamp examination revealed epithelial defects. The patient received conservative care with extensive saline irrigation and conservative treatment with 0.3% gatifloxacin, 1% prednisolone, and carbomer eye drops. Among the various antiseptic solutions, ethanol markedly decreases cell viability in a concentration-dependent manner by inducing cell lysis, even after short exposure. Moreover, chlorhexidine induces corneal toxicity, necessitating corneal transplantation. Therefore, surgeons should be aware of the complications associated with the use of chlorhexidine or alcohol-containing antiseptics and the use povidone for its low ocular toxicity.