• Gregory J Bever, Frank L Brodie, and David G Hwang.
• Department of Ophthalmology and Cornea Service, University of California San Francisco, San Francisco, California, USA.
• World Neurosurg. 2016 Dec 1; 96: 610.e1-610.e4.

BackgroundChlorhexidine 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.Case DescriptionWe 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.ConclusionsIf 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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