Medication Summary

Medical therapy for toxic anterior segment syndrome (TASS) includes corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs).^{[1, 2]}

Class Summary

NSAIDs inhibit enzyme cyclooxygenase and also can be used in the prevention of cystoid macular edema (CME). NSAIDs are administered topically, usually for 3-4 months.

Nepafenac ophthalmic (Nevanac)

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Nonsteroidal anti-inflammatory prodrug for ophthalmic use. Following administration, converted by ocular tissue hydrolases to amfenac, an NSAID. Inhibits prostaglandin H synthase (cyclooxygenase), an enzyme required for prostaglandin production. Indicated for treatment of pain and inflammation associated with cataract surgery.

Diclofenac ophthalmic (Voltaren)

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Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclooxygenase, which, in turn, decreases formation of prostaglandin precursors. Commonly used in the treatment of CME and postoperative inflammation in patients who have undergone cataract extraction.

Ketorolac ophthalmic (Acular)

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For treatment of CME and postoperative inflammation in patients who have undergone cataract extraction. Inhibits prostaglandin synthesis by decreasing activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors, which, in turn, results in reduced inflammation.

Class Summary

These agents decrease inflammation. Corticosteroid treatment is often initiated only after consultation with an ophthalmologist.

Prednisolone acetate 1% (Pred Forte, Omnipred Plus)

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Strongest steroid of its group and best choice for uveitis. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Follow-up

Media Gallery

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.

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Author

Jean Deschênes, MD, FRCSC Professor, Research Associate, Director, Uveitis Program, Department of Ophthalmology, McGill University Faculty of Medicine; Senior Ophthalmologist, Clinical Director, Department of Ophthalmology, Royal Victoria Hospital, Canada

Jean Deschênes, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, International Ocular Inflammation Society, Quebec Medical Association

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 Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

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

Chief Editor

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, Association for Research in Vision and Ophthalmology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: 1-800-DOCTORS; AbbVie; Alcon; Aldeyra; Allergan; Alphaeon; ArcScan; Baush+Lomb; Bio-Tissue; Clearside; EyeGate; Hovione; Mededicus; NovaBay; Omeros; Pentavision; Portage; Santen; Science Based Health; Senju; Shire; Sun Pharma; TearLab;TearScience;Topivert<br/>Serve(d) as a speaker or a member of a speakers bureau for: AbbVie; Alcon; Allergan; Bausch+Lomb; Bio-tissue; EyeGate;Hovione;LayerBio; NovaBay;Omeros;Portage; Santen; Shire; Stemnion; Sun Pharma;TearLab;TearScience; Topivert <br/>Received research grant from: Alcon; Aldeyra; allergan; Baush+ Lomb; EyeGate; Hovione; Kala; Ocular Therapeutix;Pfizer; RPS; Santen;Senju;Shire;Topcon; Xoma.

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.

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.

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.

Michael Ross, MD Clinical Instructor, University of British Columbia Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Sections Toxic Anterior Segment Syndrome (TASS)
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
- Medical Care
- Surgical Care
- Diet
- Activity
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Medication
Follow-up
Media Gallery
Tables
References

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

Toxic Anterior Segment Syndrome (TASS) Medication

Medication Summary

Nonsteroidal Anti-inflammatory Drugs