PMID- 34345476
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220425
IS  - 2229-5097 (Print)
IS  - 2152-7806 (Electronic)
IS  - 2152-7806 (Linking)
VI  - 12
DP  - 2021
TI  - Review: Perspective on ocular toxicity of presurgical skin preparations utilizing 
      Chlorhexidine Gluconate/Hibiclens/Chloraprep.
PG  - 335
LID - 10.25259/SNI_566_2021 [doi]
LID - 335
AB  - BACKGROUND: Chlorhexidine Gluconate (CHG), Hibiclens (4% CHG with 4% Isopropyl 
      Alcohol Detergent), and Chloraprep (i.e. labeled CHG-based solutions), utilized 
      as preoperative surgical preparatory solutions may all cause severe oculotoxicity 
      and ototoxicity. Alternatively, 10% Povidone-Iodine (PI) solutions without 
      detergent demonstrate minimal toxic effects on the eyes and ears. METHODS: Based 
      on studies from 1984 to 2021, we compared the safety/efficacy of CHG-based versus 
      PI-based solutions utilized for presurgical skin preparation near the cornea/eyes 
      and ears (i.e., predominantly for cranial or cervical spine surgery). RESULTS: 
      Some studies documented that even minimal exposure (i.e., "splash risk") during 
      face/neck skin preparation with CHG-based solutions could result in irreversible 
      corneal injury and ototoxicity. Within minutes to hours, CHG-based non-detergent 
      solutions posed the risks of; corneal epithelial edema, anterior stromal edema, 
      conjunctival chemosis, bullous keratopathy, and de-epithelialization. Notably, 
      even occlusive dressings like Tegaderm could not protect against CHG penetration. 
      Alternatively, PI-based solutions posed no to minimal ocular and/or ototoxicity, 
      while often demonstrating comparable protection against surgical site infections 
      (SSI). CONCLUSION: Chlorhexidine Gluconate (CHG), Hibiclens, and Chloraprep (i.e. 
      CHG-based solutions) are often used as skin preparations near the face/eyes/spine 
      (i.e., particularly anterior/posterior cervical procedures). However, if these 
      solutions come in contact with the eyes, corneal irritation, abrasions, and even 
      blindness may result. Alternatively, PI non-detergent solutions demonstrate 
      safety/minimal oculotoxicity/ototoxicity, while frequently showing comparable 
      efficacy against SSI.
CI  - Copyright: (c) 2021 Surgical Neurology International.
FAU - Epstein, Nancy E
AU  - Epstein NE
AD  - Clinical Professor of Neurosurgery, Schoold of Medicine, State University of New 
      York at Stony Brook, NY and in-care-of Dr. Marc Agulnick,1122 Franklin Avenue Suite 106, 
      Garden City, NY 11530.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210706
PL  - United States
TA  - Surg Neurol Int
JT  - Surgical neurology international
JID - 101535836
PMC - PMC8326148
OTO - NOTNLM
OT  - Chloraprep
OT  - Corneal toxicity
OT  - Hibiclens
OT  - Oculotoxicity
OT  - Ototoxicity
OT  - Povidone-iodine solution
OT  - Skin preparation
COIS- There are no conflicts of interest.
EDAT- 2021/08/05 06:00
MHDA- 2021/08/05 06:01
PMCR- 2021/07/06
CRDT- 2021/08/04 07:07
PHST- 2021/06/07 00:00 [received]
PHST- 2021/06/08 00:00 [accepted]
PHST- 2021/08/04 07:07 [entrez]
PHST- 2021/08/05 06:00 [pubmed]
PHST- 2021/08/05 06:01 [medline]
PHST- 2021/07/06 00:00 [pmc-release]
AID - 10.25259/SNI_566_2021 [pii]
AID - 10.25259/SNI_566_2021 [doi]
PST - epublish
SO  - Surg Neurol Int. 2021 Jul 6;12:335. doi: 10.25259/SNI_566_2021. eCollection 2021.