Deleterious effects of swimming pool chlorine on the corneal epithelium

Purpose: To study the effect of rinsing with tap and pool water on the ocular surface epithelium. Methods: Twenty eyes of 10 volunteers were irrigated in the following order with 250 mL (50 seconds) of physiological salt solution (PSS), distilled water (DW), tap water, or PSS with chlorine (0.5 mg/L). The pH of each fluid was 6.4, 6.8, 6.8, and 6.4, respectively. Vital staining, fluorophotometric assessment, and confocal microscopy were performed before and after irrigation with each fluid. Results: Eyes irrigated with PSS with chlorine showed an increase in fluorescein scores, and eyes washed with both tap water and PSS with chlorine showed an increase in Rose Bengal scores. Corneal fluorescein uptake measured by anterior fluorometer was not altered by eye irrigation with PSS, DW, or tap water. However, PSS with chlorine resulted in a significant increase in corneal fluorescein uptake. Confocal microscopy showed corneal epithelial cell damage in eyes rinsed with PSS with chlorine. Conclusions: Chlorine was determined to be potentially harmful to the corneal epithelial barrier. This study indicated the possibility that swimming without goggles might become a risk factor for corneal epithelial integrity, suggesting encouragement of goggle wear while swimming.