Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Advanced Ocular Surface and Corneal Nerve Regeneration Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Ocul Surf. 2021 Oct;22:60-71. doi: 10.1016/j.jtos.2021.06.011. Epub 2021 Jul 2.
Preoperative skin antiseptic preparation is the gold standard for prevention of surgical infection. However, improper use of antiseptics may lead to severe ocular damage. Currently, the most common surgical antiseptics can be divided into aqueous-based and alcohol-based disinfectants, with chlorhexidine and iodine/iodophors being the two major components. Chlorhexidine has a persistent antimicrobial effect and is resistant to neutralization by blood or organic products in surgical wounds. Nevertheless, due to its toxicity to the ears, meninges, and eyes, application of chlorhexidine should be prohibited in these surgical fields. Iodine/iodophor is better tolerated by the ocular surface and is the recommended antiseptic for ophthalmic or head and neck surgeries close to the periocular area. Alcohol is less pricey and has a rapid antiseptic effect, though its desiccating effect and flammability restrict the use in mucosal or laser surgeries. The single or combined use of these antiseptics may inadvertently induce severe ocular damage, especially during time-consuming head and neck surgeries with prone, hyperextension, or lateral tilt positions, or surgeries under general anesthesia. Apart from the choice of antiseptics, appropriate selection and attachment of bio-occlusive dressings are key to avoiding antiseptic-related ocular injuries. In this review, we provided a comprehensive summary of the characteristics of antiseptics used in surgical settings and the possible mechanisms and outcomes of antiseptic-related ocular injuries. The prevention, diagnosis, and acute management of these complications were also discussed.
术前皮肤消毒准备是预防手术感染的金标准。然而，消毒剂使用不当可能导致严重的眼部损伤。目前，最常见的手术消毒剂可分为水性和醇性消毒剂，其中洗必泰和碘/碘伏是两种主要成分。洗必泰具有持久的抗菌作用，并且不易被手术伤口中的血液或有机产物中和。然而，由于其对耳朵、脑膜和眼睛的毒性，应禁止在这些手术领域使用洗必泰。碘伏对眼表的耐受性更好，是眼周或头颈部手术的推荐消毒剂。酒精价格较低，具有快速的消毒作用，但由于其干燥作用和易燃性，限制了其在黏膜或激光手术中的使用。这些消毒剂的单一或联合使用可能会无意中导致严重的眼部损伤，尤其是在头颈部手术中需要长时间保持头低位、过伸位或侧倾位，或在全身麻醉下进行手术时。除了消毒剂的选择外，适当选择和使用生物闭塞性敷料对于避免与消毒剂相关的眼部损伤至关重要。在这篇综述中，我们全面总结了手术中使用的消毒剂的特点，以及消毒剂相关眼部损伤的可能机制和结果。还讨论了这些并发症的预防、诊断和急性处理。
