Toxic Anterior Segment Syndrome

A 73-year-old male with history of myopia presents with 1 day of blurry vision in the right eye after uncomplicated cataract extraction and intraocular lens implant. Patient reports mild irritation without associated pain. Vision at presentation was count fingers with normal intraocular pressure. On exam of the right eye, there was significant corneal edema with robust anterior chamber inflammation and fibrin anterior to the intraocular lens. The view to the fundus is hazy though the nerve could be delineated. Patient was suspected to have acute post operative inflammation and was treated with polymixin four times daily and preservative-free methylprednisolone every hour. He was followed very closely due to concern for endophthalmitis following cataract extraction. However, patient continue to deny pain on presentation and continues to improve with medical therapy alone. As post operative inflammation and toxic anterior segment syndrome is a diagnosis of exclusion, all patients should be ruled out for acute endophthalmitis. It is also important to be aware of the associated diagnosis of toxic posterior segment syndrome given the new advent of “dropless cataract surgery.” 

Presentation Date: 09/12/2019

Issue Date: 08/01/2020