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Benzalkonium chloride is a frequently cited offender, and care should be taken to ensure medications instilled intracamerally do not contain this preservative (69-71). This agent not only causes dose-related inflammation to extraocular structures like the conjunctiva, it is also reported to make structural alterations to the endothelium even at exceedingly low concentrations (110). It is generally recommended to avoid the intraocular use of medications and solutions that contain benzalkonium chloride, thimerosal, eidetic acid, and sodium bisulfite (111). Similar to endophthalmitis, TASS cannot be prevented completely but the rate may be reduced.
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Although these entities cannot be prevented completely, their rates may be decreased through risk reduction strategies supported by peer-reviewed evidence. Clinical outcomes of TASS are better with prompt diagnosis and treatment with topical corticosteroids and possibly cycloplegics. Typical presentations include blurred vision within 12–48 hours of surgery without salient complaints of pain; in general, TASS patients present sooner than do patients with endophthalmitis. “Limbus-to-limbus” corneal edema is characteristic of TASS and is uncommon for endophthalmitis. Other non-specific signs of anterior segment inflammation are common in both entities, such as anterior chamber cellular reaction, fibrin, and hypopyon (102). Toxic Anterior Segment Syndrome (TASS) is a rare and devastating complication of intraocular surgery.
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- TASS is a non-infectious postoperative inflammation that occurs most commonly after cataract surgery but also may occur following keratoplasty and posterior segment procedures (52-55).
- Most patients do well with medical management using topical steroids.
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