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Chlorhexidine Keratitis: Safety of Chlorhexidine as a Facial Antiseptic

Steinsapir, Kenneth D. MD; Woodward, Julie A. MD

doi: 10.1097/DSS.0000000000000822
Review Article

BACKGROUND Effective antiseptic to reduce surgical site infections is a cornerstone of modern surgery. Chlorhexidine gluconate–based antiseptics are among the most effective of these products. Unfortunately, chlorhexidine solutions are toxic to the cornea and middle ear, and they pose a splash risk to both the patient and health care personnel.

OBJECTIVE To examine the clinical evidence that led to the disavowal of chlorhexidine antiseptic solution for use on the face and head.

METHODS AND MATERIALS Reference searches were performed using PubMed, Embase, and LexisNexis databases without restriction to the date of publication, language, or study setting.

RESULTS The literature revealed 11 sentinel cases of severe chlorhexidine-related keratitis in the late 1980s. These cases are reviewed together with data on ototoxicity and alternative products to understand why chlorhexidine solution should not be used on the face and scalp.

CONCLUSION Chlorhexidine antiseptic solutions are highly effective. However, they pose a risk to the middle ear and have the potential to irreversibly damage the cornea with a minimal splash exposure. Povidone–iodine is a safe and effective alternative.

Supplemental Digital Content is Available in the Text.

*Division of Ophthalmic Plastic and Reconstructive Surgery, Jules Stein Eye Institute, David Geffen School of Medicine, Los Angeles, California;

Associate Professor of Ophthalmology and Dermatology, Chief Oculofacial Surgery, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to: Kenneth D. Steinsapir, MD, 9001 Wilshire Blvd, Suite 305, Beverly Hills, CA 90211, or e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal's Web site (

The authors have indicated no significant interest with commercial supporters.

© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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