J Korean Ophthalmol Soc.  2019 Apr;60(4):374-379. 10.3341/jkos.2019.60.4.374.

A Case of Corneal Chemical Injury by High-dose Ethanol during Orbital Wall Fracture Repair

• Lee JY
• Choi JY
• Jeong J

• KMID: 2443155
• DOI: http://doi.org/10.3341/jkos.2019.60.4.374

Abstract

PURPOSE
To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair.
CASE SUMMARY
A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased.
CONCLUSIONS
The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.

Keyword

Chemical injury; Cornea; Endothelial cell loss; Ethanol-containing antiseptics

MeSH Terms

Anti-Bacterial Agents
Chlorhexidine
Cornea
Corneal Injuries
Corneal Surgery, Laser
Disinfection
Edema
Endothelial Cells
Ethanol*
Humans
Male
Middle Aged
Ophthalmic Solutions
Orbit*
Punctures
Skin
Steroids
Anti-Bacterial Agents
Chlorhexidine
Ethanol
Ophthalmic Solutions
Steroids

Figure

• 

  Figure 1 Slit-lamp photographs of the cornea in the left eye with chemical injury at the initial presentation. (A) Anterior segment photograph shows perilimbal injection, severe stromal edema, Descemet's membrane folding, and opacity in his left eye. (B) Anterior segment photograph shows about 11 × 6 mm sized corneal epithelial defect combined with perilimbal conjunctival epithelial defect in his left eye.

• 

  Figure 2 Anterior segment optical coherence tomography images of the cornea in the left eye with chemical injury at the initial presentation. (A–C) showing high density of endothelium layer, swelling of multiple endothelial cells.

• 

  Figure 3 Qualitative and quantitative analysis of central corneal endothelial cell in the left eye with chemical injury. (A) Corneal endothelium after 3 days following chemical injury of cornea is shown. The endothelial cell density was 1,316 cells/mm2. (B) The endothelial cell density of the damaged left cornea was 530 cells/mm2. The coefficient of variation in cell size was 40 and the percentage of hexagonal cells was 31% in corneal endothelial cells of chemical injury of cornea after 4 weeks following phototherapeutic keratectomy in the left eye. CD = cell density; SD = standard deviation; CV = coefficient of variation; AVE = average; NUM = number; PACHY = pachymeter.

• 

  Figure 4 Slit-lamp photographs of the cornea in the left eye with chemical injury after treatment. (A, B) Corneal epithelial defect and corneal edema were decreased a week after the initial treatment. The patient complained visual disturbance and pain in his left eye 2 months after the first recovery. Corneal epithelial defect and stromal edema were recurred. (C, D) Corneal stromal edema and Descemet's membrane folding at the inferior aspect of the cornea have recurred. (E, F) Corneal epithelial defect with punctate epithelial erosions were decreased after anterior stromal puncture and phototherapeutic keratectomy.

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