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Chlorhexidine-related ulcerative keratopathy

Poster Details

First Author: M.Sarnat-Kucharczyk POLAND

Co Author(s):    E. Mrukwa-Kominek              

Abstract Details

Purpose:

To present corneal changes in overuse of topical 0,02% chlorhexidine solution used as a treatment in contact lens-related acanthamoeba keratitis.

Setting:

Department of Ophthalmology, University Center of Ophthalmology and Oncology, Medical University of Silesia, Katowice, Poland

Methods:

35-year-old male was sent to our University Hospital for ophthalmic consultation after 2 weeks unsuccessful therapy of keratitis. Confocal microscopy revealed acanthamoeba cysts. The patient received topical 0,02% chlorhexidine for 5 days 4x daily and 0.1% Propamidine Isetionate 4x daily in the left eye . Despite the need of cessation, the patient was given chlorhexidine for 8 weeks and he did not want to withhold it. He was well informed of chlorhexidine toxicity, and that the overuse of this drug has fatal results. Though he was strongly convinced, that it will kill all acanthamoeba cysts. The patient developed severe keratopathy due to permanent overuse of topical 0,02% chlorhexidine solution. After two months he was admitted to another ophthalmic hospital and has received chlorhexidine for next 28 days. He was still in our outpatient's clinic. The patient refused to stop using chlorhexidine. Best corrected visual acuity: right eye 1.0, left eye hand motion. The corneal stroma was cloudy and persistent epithelial defect developed. Despite concomitant ocular therapy including lubricating eye drops, ointments, epithelial defect did not heal. Severe ocular complications such as white cataract, permanent wide mydriasis have developed after chlorhexidine treatment.

Results:

Topical chlorhexidine may have good results in enhancing acanthamoeba keratitis treatment. Chlorhexidine exhibits not only antitrophozoite activity but also is lethal to the cyst form. Because it is highly toxic to cornea, this drug should be used with caution. Lack of awareness of harmfulness, prolonged use of chlorhexidine and patient noncompliance may result in severe toxic chlorhexidine ulcerative keratopathy. In this situation perforative keratoplasty is the only option to improve visual acuity.

Conclusions:

-

Financial Disclosure:

NONE

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