TOXIC KERATOPATHY DUE TO THE ACCIDENTAL USE OF CHLORHEXIDINE, CETRIMIDE AND CIALIT

Due to economical reasons some ophthalmologists are using an irrigatin g solution made by the hospital pharmacy instead of the commercially a vailable solutions. These irrigating solutions come in bottles which a re identical to the ones used for other solutions. During the last thr ee years bottles were accidentally mixed up five times. Consequently, bottles containing solutions such as chlorhexidine, cetrimide, chlorhe xidine/cetrimide and cialit solutions were used during cataract surger y. This resulted in immediate corneal edema which, in its turn resulte d in a bullous keratopathy. Four patients underwent a penetrating kera toplasty. In one patient the cornea was covered with a conjunctival fl ap. Light microscopy of the corneas included epithelial edema, loss of keratocytes, and a disrupted and sometimes absent endothelial cell la yer.