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Deleterious Effects of Swimming Pool Chlorine on the Corneal Epithelium

Ishioka, Misaki MD*†; Kato, Naoko MD†‡; Kobayashi, Akira MD§; Dogru, Murat MD†‡; Tsubota, Kazuo MD†‡

doi: 10.1097/ICO.0b013e318156d200
Clinical Science

Purpose: To study the effect of rinsing with tap and pool water on the ocular surface epithelium.

Methods: Twenty eyes of 10 volunteers were irrigated in the following order with 250 mL (50 seconds) of physiological salt solution (PSS), distilled water (DW), tap water, or PSS with chlorine (0.5 mg/L). The pH of each fluid was 6.4, 6.8, 6.8, and 6.4, respectively. Vital staining, fluorophotometric assessment, and confocal microscopy were performed before and after irrigation with each fluid.

Results: Eyes irrigated with PSS with chlorine showed an increase in fluorescein scores, and eyes washed with both tap water and PSS with chlorine showed an increase in Rose Bengal scores. Corneal fluorescein uptake measured by anterior fluorometer was not altered by eye irrigation with PSS, DW, or tap water. However, PSS with chlorine resulted in a significant increase in corneal fluorescein uptake. Confocal microscopy showed corneal epithelial cell damage in eyes rinsed with PSS with chlorine.

Conclusions: Chlorine was determined to be potentially harmful to the corneal epithelial barrier. This study indicated the possibility that swimming without goggles might become a risk factor for corneal epithelial integrity, suggesting encouragement of goggle wear while swimming.

From the *Ryogoku Eye Clinic, Tokyo, Japan; †Department of Ophthalmology, Tokyo Dental College, Chiba, Japan; ‡Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and §Department of Ophthalmology, Kanazawa University, Kanazawa, Japan.

Received for publication April 3, 2007; revision received June 27, 2007; accepted July 10, 2007.

The authors state that they have no propriety interest in any of the products named in this article.

Reprints: Misaki Ishioka, Ryogoku Eye Clinic, 4-33-12 Ryogoku, Sumida-ku, Tokyo 130-0026, Japan (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.