To report two cases of toxic corneal reaction induced by infusion of distilled water into anterior chamber during cataract surgery.

The first case was a 60-year-old female who was inadvertently infused with distilled water for 20 minutes during phacoemulsification in place of balanced salt solution (BSS). The second case was a 70-year-old male who received anterior chamber irrigation with distilled water for approximately 1 minute then and then immediately irrigated with BSS as soon as the mistake was identified. In both cases, topical 1% prednisolone acetate and 5% NaCl solution was immediately administered every hour as well as oral prednisolone at 1 mg/kg for one week after which the dose was slowly tapered. The first case completely returned to normal after 3 months, whereas the second case only requied 1 month to return to pre-surgery conditions.

Patients who were exposed to distilled water within the anterior chamber resulted in corneal endothelial damage and corneal edema proportionate to the amount irrigated. However, The corneal edema gradually healed with treatment and eventually regained translucency without complications, completely.