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Updated: Aug 13, 2026

Intravitreous Injection for Establishing Ocular Diseases Model
Published on: October 1, 2007
Toxic endothelial cell destruction from intraocular benzalkonium chloride
H Liu1, I Routley, K D Teichmann
1Orana Eye Centre, Dubbo, New South Wales, Australia.
Purpose:
To present a cluster of cases of corneal edema occurring after phacoemulsification.
Setting:
Regional hospital in rural Australia.
Methods:
This retrospective case series comprised 12 patients from a single surgical list comprising 19 cases who developed persistent corneal edema after having phacoemulsification.
Results:
After 6 months, the edema improved in 1 patient. Inadvertent intraocular use of balanced salt solution (BSS) preserved with benzalkonium chloride was found to be the cause of this serious complication.
Conclusions:
Benzalkonium chloride in concentrations commonly used extraocularly is highly toxic to the corneal endothelium. Every possible safeguard should be taken to prevent inadvertent intraocular use of such preserved solutions.
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