Benzalkonium chloride corneal toxicity post-cataract surgery

Keith Ong*, Leonard Ong

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Two patients with presumed benzalkonium chloride (BAK) corneal toxicity after routine cataract surgery are presented. Patient 1 had corneal stroma and Descemet’s membrane folds. Patient 2 had moderate superficial punctate epithelial erosions (SPEE). They were on Chlorsig, Maxidex, and Acular eye drops tds postoperatively. The corneas of these two patients improved when BAK was removed or minimized from the postoperative eye drop regimen. Two vials of 1 ml dexamethasone 4mg/ml for injection were added to Chlorsig 10 ml bottle to substitute for Maxidex eye drops. BAK toxicity should be suspected when the cornea is not as clear as expected postoperatively. A practical way to eliminate BAK from postoperative eye drops is described, and would be useful until pharmaceuticals mass-produce BAK-free steroid eye drops economically.

Original languageEnglish
Pages (from-to)56-60
Number of pages5
JournalAsian Journal of Ophthalmology
Issue number1
Publication statusPublished - 2020


  • Benzalkonium chloride (BAK)
  • Cataract surgery
  • Corneal toxicity


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