Dry eye disease (DED) is a hallmark of primary Sjögren’s disease (SjD) and often resists conventional treatments like lubricant eye drops. Insulin nanoemulsions offer a potential solution by improving drug penetration and retention on the ocular surface. In animal models, insulin has shown benefits in promoting tear secretion and corneal healing. This study evaluated the safety and efficacy of insulin nanoemulsion eye drops (20 IU/mL, three times daily for 30 days) in patients with SjD. Thirty-two patients were randomized in a double-masked design to receive either insulin or placebo drops. Symptoms (assessed by OSDI questionnaire) and objective measures (tear film breakup time, corneal and conjunctival staining, and Schirmer Test) were recorded at baseline, after 4 weeks of treatment, and at a 4-week follow-up. Twenty-three participants completed the study. Both groups showed significant improvement in symptoms and objective signs after treatment (p < 0.05), but no significant differences were found between the insulin and placebo groups. No clinically relevant adverse effects were reported. Insulin nanoemulsion eye drops are safe for SjD patients, but their therapeutic advantage remains unclear. Further studies with larger samples, extended follow-up, and dose adjustments are needed to better understand their potential.

Chlorhexidine (CHX) is an antiseptic used in facial and skull surgeries with potential ocular contact. It is also a preservative for eye drops and contact lens products and is used to treat infectious keratitis. Reports of corneal toxicity to CHX exist at different concentrations and presentations. The present study clarifies the mechanisms of CHX and corneal toxicity, as well as the treatment and its outcomes. Two sources of data were used: a) Reports of toxicity to the cornea by CHX at different concentrations in in vitro studies and case reports, collected from the medical literature in PubMed between 1980 and 2024 using the terms "chlorhexidine" AND "cornea"; b) Cases observed by our group (tertiary hospital service) between 2021 and 2024 were compiled. Sixteen clinical articles describing CHX keratitis were identified. In addition, four cases of chemical keratitis secondary to CHX antisepsis were treated at our referral center between 2021 and 2024. Corneal damage varies according to the vehicle, concentration, route of exposure, and duration of exposure. Thirty-nine cases of severe corneal CHX toxicity were reported. Thirteen patients underwent corneal transplantation because of severe vision loss. Using CHX as an antiseptic in regions with potential eye contact can cause keratitis and serious visual impairment. Ocular protection with lubricant ointment and closure before applying this transparent antiseptic to the patient's face under general anesthesia can partially prevent the lesions. The main antiseptic alternative is 10% aqueous povidone-iodine, which is similar in cost and effectiveness to chlorhexidine.