The Effects of Povidone-Iodine and Chlorhexidine Gluconate on the Ocular Surface in Phacoemulsification

Abstract Purpose: To compare the effects of 5% povidone-iodine (PI) and 0.1% chlorhexidine gluconate (CHG) on ocular surface parameters and patient comfort following phacoemulsification cataract surgery. The study aimed to determine whether CHG offers advantages over PI in terms of ocular surface recovery and postoperative comfort. Methods: This prospective, randomized controlled trial included 61 patients undergoing phacoemulsification for senile cataract. Participants were randomly assigned to conjunctival irrigation with either 5% PI or 0.1% CHG for 3 minutes before surgery. Ocular surface assessments included Schirmer test, tear break-up time (TBUT), tear meniscus height (TMH), and the Ocular Surface Disease Index (OSDI). Evaluations were performed preoperatively and postoperatively at Week 1, Month 1, and Month 3. Pain scores were recorded using a numerical rating scale within the first 24 hours. Results: Baseline parameters were comparable between groups. At Week 1, OSDI scores were significantly higher in the PI group than in the CHG group (p = 0.029). Both groups showed significant early postoperative deterioration of ocular surface parameters, but recovery was faster in the CHG group. TBUT remained significantly reduced in the PI group at Month 3, whereas CHG eyes normalized. Schirmer values returned to baseline by Month 1 in both groups. Postoperative pain scores were significantly higher in the PI group (p < 0.001). Conclusion: Both PI and CHG caused transient ocular surface changes after cataract surgery. However, CHG demonstrated faster recovery of tear film parameters and improved early postoperative comfort, suggesting it may be a preferable antiseptic in patients with ocular surface sensitivity.