{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:14:30Z","timestamp":1790900070902,"version":"4.1.0"},"reference-count":9,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>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).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>Some studies documented that even minimal exposure (i.e., \u201csplash risk\u201d) 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).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_566_2021","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T13:30:22Z","timestamp":1625578222000},"page":"335","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Review: Perspective on ocular toxicity of presurgical skin preparations utilizing Chlorhexidine Gluconate\/Hibiclens\/Chloraprep"],"prefix":"10.25259","volume":"12","author":[{"given":"Nancy E","family":"Epstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"key":"10.25259\/SNI_566_2021\/ref-1","doi-asserted-by":"crossref","first-page":"610.e1","DOI":"10.1016\/j.wneu.2016.09.035","article-title":"Corneal injury from presurgical chlorhexidine skin preparation","volume":"96","author":"Bever","year":"2016","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_566_2021\/ref-2","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1080\/02713683.2017.1408128","article-title":"Performance of bio-occlusive dressing as barrier protection from presurgical chlorhexidine skin preparation","volume":"5","author":"Brodie","year":"2018","journal-title":"Curr Eye Res"},{"key":"10.25259\/SNI_566_2021\/ref-3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1056\/NEJMoa0810988","article-title":"Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis","volume":"362","author":"Darouiche","year":"2010","journal-title":"N Engl J Med"},{"key":"10.25259\/SNI_566_2021\/ref-4","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3171\/2017.5.SPINE17158","article-title":"Preoperative skin antisepsis with chlorhexidine gluconate versus povidone-iodine: A prospective analysis of 6959 consecutive spinal surgery patients","volume":"28","author":"Ghobrial","year":"2018","journal-title":"J Neurosurg Spine"},{"key":"10.25259\/SNI_566_2021\/ref-5","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0002-9394(14)76094-5","article-title":"The corneal toxicity of presurgical skin antiseptics","volume":"97","author":"Mac Rae","year":"1984","journal-title":"Am J Ophthalmol"},{"key":"10.25259\/SNI_566_2021\/ref-6","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/00003226-200203000-00026","article-title":"Progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate (0.02%)","volume":"21","author":"Murthy","year":"2002","journal-title":"Cornea"},{"key":"10.25259\/SNI_566_2021\/ref-7","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/DSS.0000000000002447","article-title":"The use of chlorhexidine as a skin preparation on the head and neck: A systematic review of ocular and ototoxicity","volume":"47","author":"Shive","year":"2021","journal-title":"Dermatol Surg"},{"key":"10.25259\/SNI_566_2021\/ref-8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/DSS.0000000000000822","article-title":"Chlorhexidine keratitis: Safety of chlorhexidine as a facial antiseptic","volume":"43","author":"Steinsapir","year":"2017","journal-title":"Dermatol Surg"},{"key":"10.25259\/SNI_566_2021\/ref-9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/BF01203289","article-title":"Toxic keratopathy due to the accidental use of chlorhexidine, cetrimide and cialit","volume":"90","author":"van Rij","year":"1995","journal-title":"Doc Ophthalmol"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/review-perspective-on-ocular-toxicity-of-presurgical-skin-preparations-utilizing-chlorhexidine-gluconate-hibiclens-chloraprep\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/review-perspective-on-ocular-toxicity-of-presurgical-skin-preparations-utilizing-chlorhexidine-gluconate-hibiclens-chloraprep\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T13:30:32Z","timestamp":1625578232000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/review-perspective-on-ocular-toxicity-of-presurgical-skin-preparations-utilizing-chlorhexidine-gluconate-hibiclens-chloraprep\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,6]]},"references-count":9,"alternative-id":["10.25259\/SNI_566_2021"],"URL":"https:\/\/doi.org\/10.25259\/sni_566_2021","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,6]]},"article-number":"335"}}