Further Outpatient Care
Initially, patients with toxic anterior segment syndrome (TASS) should be examined on a daily basis to assess their response to treatment.
Once the inflammation is resolved, patients need to be assessed carefully for corneal and/or trabecular meshwork damage. [1, 2]
Deterrence/Prevention
All preoperative, intraoperative, and postoperative steps at the surgical center should be thoroughly assessed, including the following [1, 2] :
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Surgical equipment and instruments
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Sterilization process
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Preoperative, intraoperative, and postoperative medications
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Ultrasound water
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Irrigating solutions
Complications
Depending on the type of toxin, duration of exposure, and response to treatment, the following complications may result [1, 2] :
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Corneal endothelial cell loss with resultant edema
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Trabecular meshwork damage causing glaucoma
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Iris sphincter muscle damage with resultant permanent dilated pupil
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Cystoid macular edema
Prognosis
Prognosis is generally divided into three groups depending on the severity of TASS.
A mild presentation of TASS will result in rapid clearing of the corneal edema with no long-term corneal or trabecular damage and normal or near normal visual acuity.
A moderate presentation of TASS will result in a persistent corneal edema that will take several weeks to clear, intraocular pressure that is difficult to control, and a moderate effect on visual acuity.
A severe presentation of TASS will result in a marked corneal edema that does not clear, iris and trabecular meshwork damage with resultant glaucoma, and possible cystoid macular edema. Visual outcome is usually poor despite medical or surgical intervention. A potential sequel manifestation of TASS is Urrets-Zavalia syndrome (UZS). [7]
Despite the above descriptions, predicting the outcome for patients remains difficult because of the multiple etiologies and associations linked to TASS.
Patient Education
Patients should be instructed to immediately report any pain and/or a decline in visual acuity postoperatively. The sooner that TASS can be detected and treated, the better the outcome will be for the patients.
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Diffuse limbus-to-limbus corneal edema and anterior segment inflammation noted in a patient with toxic anterior segment syndrome (TASS).
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Long-term sequelae of toxic anterior segment syndrome (TASS) with persistent corneal edema.
Tables
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 |
