Trial of chlorhexidine gluconate for fungal corneal ulcers

Ophthalmic Epidemiol. 1997 Sep;4(3):141-9. doi: 10.3109/09286589709115721.


Aims: Suppurative corneal ulcers due to filamentous fungi are a serious and intractable problem in many tropical developing countries. In vitro studies and a small pilot study have shown that chlorhexidine gluconate is effective. The aim was to establish the optimum concentration which would be appropriate to use in a larger randomized clinical trial.

Methods: A masked randomized clinical trial of three concentrations of chlorhexidine compared with natamycin 5% was carried out in consecutive patients with established corneal ulcers shown by microscopy to contain fungal hyphae and later proven to be culture positive. Topical treatments were applied 1/2-hourly to 2-hourly for up to 5 days, with reduced frequency thereafter, and all patients were re-assessed at 21 days.

Results: Of 60 patients entered in the trial, 2 were lost to follow-up, and 12 were classified as 'severe' with little prospect of recovery. At 5 days the response was related to the concentration of chlorhexidine, with 0.2% giving the best results. Compared with the response to natamycin as the referent, the relative efficacy was 1.17 with chlorhexidine 0.05%, 1.43 with 0.1%, and 2.00 with 0.2%. The superiority of 0.2% chlorhexidine over natamycin was statistically significant (relative efficacy 2.20, p = 0.043) in patients not having had prior antifungal treatment.

Conclusions: This preliminary study justifies further trials of chlorhexidine as a primary treatment for fungal corneal ulcers in circumstances where specific antifungal agents are not available.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Anti-Infective Agents, Local / administration & dosage
  • Anti-Infective Agents, Local / therapeutic use*
  • Child
  • Child, Preschool
  • Chlorhexidine / administration & dosage
  • Chlorhexidine / analogs & derivatives*
  • Chlorhexidine / therapeutic use
  • Cornea / microbiology
  • Corneal Ulcer / drug therapy*
  • Corneal Ulcer / microbiology
  • Dose-Response Relationship, Drug
  • Eye Infections, Fungal / drug therapy*
  • Eye Infections, Fungal / microbiology
  • Female
  • Follow-Up Studies
  • Fusarium / isolation & purification
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Natamycin / administration & dosage
  • Natamycin / therapeutic use
  • Ophthalmic Solutions
  • Treatment Outcome


  • Anti-Infective Agents, Local
  • Ophthalmic Solutions
  • Natamycin
  • chlorhexidine gluconate
  • Chlorhexidine