안와골절정복술 시 사용된 고농도 에탄올에 의한 각막화상 1예
A Case of Corneal Chemical Injury by High-dose Ethanol during Orbital Wall Fracture Repair
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목적: 수술 부위 소독에 사용된 고농도 에탄올에 의해 발생한 각막화상 1예를 보고하고자 한다. 증례요약: 56세 남자 환자가 우측 안와골절정복술을 받던 중, 안면부 소독을 위해 사용한 2% 헥시타놀 용액(2% Chlorhexidine, 72% Ethanol 혼합액)이 좌안에 흘러 들어간 채로 수술을 마치고 나서 발생한 통증을 주소로 내원하였다. 세극등현미경검사상 좌안 윤부주위 결막충혈, 각막하측상피 결손과 기질 전체의 심한 혼탁 및 부종이 관찰되었다. 고농도 에탄올에 의한 좌안 각막화학화상으로 진단하고, 항생제 및 국소 스테로이드 점안 치료를 시작하였다. 1주 후 각막상피결손은 호전되었으나, 치료 2개월째 내피세포 기능저하와 함께 반복각막미란이 재발되어, 앞기질천자술과 치료레이저각막절제술을 시행하였다. 이후 각막상피결손 및 미란은 호전되었으나, 내피세포 밀도는 매우 감소하였다. 결론: 2% 헥시타놀 용액은 수술 전 피부소독을 위해 사용되고 있으나 고농도의 에탄올을 함유하고 있다는 사실은 간과하기 쉽다. 고농도의 에탄올 용액이 안구에 노출되면 각막내피세포 부전 및 각결막 윤부세포의 손상을 포함한 심한 각막손상을 초래할 수 있기에 주의하여야 한다.
Abstract
Purpose: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. Case summary: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. Conclusions: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.
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