Blebitis

• An uncommon but significant early- to late-onset complication of glaucoma filtering surgery.

Risk Factors

• Full thickness filtering surgery
• Use of antifibrotic agents such as 5-fluorouracil (5-FU) and mitomycin-C (MMC)
• Late-onset filtering bleb leakage
• Inferior location of the filtering bleb
• Blepharitis or ocular surface disease

Clinical Features

• Symptoms: pain and/or red eye (either sudden or sub-acute), decreased vision, ocular irritation, light sensitivity
• Signs:
  • Milky-appearing ischemic bleb surrounded by intense conjunctival hyperemia
  • Anterior chamber inflammatory reaction
  • Mucopurulent infiltrate within the bleb
  • Mild to moderate anterior segment inflammation
  • Hypotony if associated with bleb leakage
  • May be complicated with full-blown endophthalmitis

Management

• Workup: 
  • Culture bleb with conjunctival swab (and anterior chamber tap for more severe infection)
  • B-scan ultrasound to rule out posterior segment involvement
• Mild to moderate infection: 
  • Intensive topical antibiotics 
  • Topical steroids when appropriate
  • Cycloplegics if indicated
  • Frequent follow-up (often daily)
• Severe infection
  • Hospitalization
  • Intravenous antibiotic therapy
  • Hourly topical fortified antibiotics
  • Cycloplegicss
  • Topical or intravitreal steroids
  • Vitrectomy in cases of worsening despite aggressive therapy
• Visual prognosis is good with prompt and aggressive therapy