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The Patient Experience: 5% Povidone-Iodine vs 0.05% Aqueous Chlorhexidine

Brandon Bates1, Edward Wood1, Philip Storey1

  • 1Austin Retina Associates, University of Texas Dell Medical School, Austin, Texas.

Ophthalmic Surgery, Lasers & Imaging Retina
|March 12, 2026
PubMed

Insights

Aqueous chlorhexidine (aqCHX) offers a gentler alternative for intravitreal injections compared to povidone-iodine (PI). Patients reported less pain and greater satisfaction with aqCHX, suggesting improved tolerability.

Area of Science:

  • Ophthalmology
  • Infectious Disease Prevention
  • Patient Experience Research

Background:

  • Intravitreal injections require antiseptic preparation.
  • Povidone-iodine (PI) is a common antiseptic, but can cause ocular discomfort.
  • Aqueous chlorhexidine (aqCHX) is being explored as a potentially gentler alternative.

Purpose of the Study:

  • To compare patient experiences and tolerability of aqCHX versus PI for intravitreal injection antisepsis.
  • To evaluate differences in ocular pain, irritation, vision changes, and overall satisfaction.

Main Methods:

  • A single-center patient survey was conducted.
  • 141 patients receiving PI and 92 patients receiving aqCHX for intravitreal injections were surveyed.
  • Patient-reported outcomes including pain, irritation, vision changes, and satisfaction were compared.

Main Results:

  • Patients receiving aqCHX reported significantly less ocular pain and irritation at one hour (P=.005) and one day (P=.027) post-injection compared to PI.
  • Greater patient satisfaction was reported with aqCHX (P=.014).
  • A lower frequency of participants experienced worsened vision with aqCHX (19.6%) versus PI (33.6%, P=.02).

Conclusions:

  • Aqueous chlorhexidine (aqCHX) demonstrates improved tolerability and patient experience compared to povidone-iodine (PI) for intravitreal injection antisepsis.
  • The findings suggest aqCHX may be a preferable antiseptic agent for patients undergoing intravitreal injections.
  • Further research could validate these patient-reported outcomes in larger, multi-center trials.

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