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Toxic Anterior Segment Syndrome Treatment & Management

  • Author: Ahmed R Al-Ghoul, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Sep 09, 2014
 

Medical Care

Patients should be treated as if infectious endophthalmitis is present if the clinical picture is unclear as to the exact etiology of the inflammation.

Once TASS is confirmed, patients should be started on topical steroids. The usual regimen is 1 drop every 30-60 minutes for the first 3 days with gradual tapering.

The response is typically rapid once patients are started on topical steroids. Patients should be reassessed later the same day or the next day to help confirm that the condition is indeed TASS versus infectious endophthalmitis, in which case, steroids alone would worsen the condition.

Careful assessment and treatment of elevated intraocular pressure is important to prevent optic nerve damage.

Nonsteroidal anti-inflammatory drops have been shown to be a helpful adjunct in several cases of TASS.

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Surgical Care

No clear benefit has been demonstrated for immediate anterior chamber washout. In cases of a severe and refractory fibrin reaction due to TASS, intracameral recombinant tissue plasminogen activator (r-tPA) may be beneficial.[3]

In cases where the intraocular lens is suspected to be the cause of the inflammation, an intraocular lens exchange may be needed if no response to medical treatment is demonstrated.

If corneal edema persists for more than 6 weeks despite medical treatment, the corneal decompensation is likely permanent and a corneal transplantation is required. See the image below.

Long-term sequelae of toxic anterior segment syndr Long-term sequelae of toxic anterior segment syndrome (TASS) with persistent corneal edema.

If intraocular pressure cannot be controlled medically, seton valve procedures may be required.

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Contributor Information and Disclosures
Author

Ahmed R Al-Ghoul, MD, FRCSC Clinical Lecturer, Department of Surgery, Division of Ophthalmology, University of Calgary Faculty of Medicine, Canada

Ahmed R Al-Ghoul, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Canadian Medical Association, Canadian Ophthalmological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Puwat Charukamnoetkanok, MD Assistant Professor of Ophthalmology, University of Pittsburgh School of Medicine

Puwat Charukamnoetkanok, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Deepinder K Dhaliwal, MD Associate Professor of Ophthalmology, University of Pittsburgh School of Medicine; Director of Refractive Surgery and Director of Cornea and External Disease Service, University of Pittsburgh Medical Center Eye Center; Medical Director of Laser/Vision Center, University of Pittsburgh Medical Center; Founder and Director, Center for Integrative Eye Care, University of Pittsburgh Medical Center

Deepinder K Dhaliwal, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

References
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Diffuse limbus-to-limbus corneal edema and anterior segment inflammation noted in a patient with toxic anterior segment syndrome (TASS).
Long-term sequelae of toxic anterior segment syndrome (TASS) with persistent corneal edema.
Table 1. Differentiating Toxic Anterior Segment Syndrome and Infectious Endophthalmitis
Signs and Symptoms TASS Infectious Endophthalmitis
Onset 12-24 hours usually 2-7 days usually
Pain Usually none but can be mild to moderate Usually severe
Corneal edema Limbus to limbus Specific to area of trauma
Intraocular pressure May increase suddenly Usually not elevated
Anterior chamber inflammation Moderate-to-severe anterior chamber reaction with increased white blood cells and fibrin. Hypopyon may be noted. Moderate-to-severe anterior chamber reaction. Fibrin is variable. Hypopyon often present (75% of the time).
Vitritis Very rare Always present
Pupil Fixed and dilated Reactive
Lid swelling Usually not evident Often present
Visual acuity Decreased Decreased
Response to steroids Dramatic improvement Equivocal
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