A Case of Unilateral Corneal Edema after Exposure to 0.12% Cholorohexidine

Purpose: We report a case of permanent corneal opacity caused by unilateral chemical burns after exposure to a low-dose (0.12%) chlorhexidine antiseptic solution during a dental procedure. Case summary: A 33-year-old woman presented to our clinic with conjunctival injection, ocular irritation, and blurred vision in her right eye; all symptoms had been present for 2 weeks. These symptoms began several hours after a dental procedure, in which 0.12% chlorhexidine antiseptic solution had been splashed into the right eye. Initial examination revealed that the patient's best-corrected visual acuity (BCVA) was 20/200 in the right eye. Slit lamp examination and anterior segment optical coherence tomography revealed substantial corneal edema and stromal infiltration on the nasal side. The patient's BCVA improved to 20/20 in the right eye after 3 months of treatment with topical corticosteroid. However, the stromal opacity was permanent and the corneal endothelial cell count was substantially reduced to approximately 550 cells/mm2 . Conclusions: Low-dose (0.12%) chlorhexidine on the ocular surface may cause irreversible corneal opacity and chemical burn-induced endothelial cell damage.