What are the other Names for this Condition? (Also known as/Synonyms)

• BAE (Bleb Associated Endophthalmitis)
• Bleb Related Endophthalmitis

What is Bleb Associated Endophthalmitis? (Definition/Background Information)

• Trabeculectomy is a surgical procedure for treating glaucoma. In this procedure, a tiny hole is created on the conjunctiva (eye surface) to drain fluid from inside the eye, in order to regulate the eye pressure. This tiny hole, placed behind the upper eyelid, is known as the “bleb”
• Blebitis is a rare infection of the bleb occurring within a few months to even a few years after glaucoma filtration surgery (trabeculectomy). This post-operative complication is a form of bleb-related infection
• When the infection progresses to involve eye structures beyond the anterior chamber, the condition is termed Bleb Associated Endophthalmitis (BAE). The anterior chamber of the eye, is the front part of the eye, lying between the cornea and iris
• Bleb Associated Endophthalmitis can be early-onset or late-onset but is a more severe form that can cause blindness if not addressed aggressively. Nevertheless, even with therapy, the outcomes are generally poor in BAE

Who gets Bleb Associated Endophthalmitis? (Age and Sex Distribution)

• Bleb Associated Endophthalmitis is rare and is only observed in individuals who have undergone eye surgery (trabeculectomy) for glaucoma
• Both males and females may be affected
• Worldwide, individuals of all races and ethnicity are prone to developing the condition

What are the Risk Factors for Bleb Associated Endophthalmitis? (Predisposing Factors)

The risk factors for Bleb Associated Endophthalmitis may include:

• Bleb leaks: It may occur immediately following surgery (within 3 months), or after a certain period of time
• Administration of antifibrotic agent (mitomycin-C), either during or after surgery
• Improper location of the bleb
• Inflammation of the eyelids (blepharitis)
• Infection of the conjunctiva (conjunctivitis)
• Upper respiratory infections
• Uncontrolled diabetes
• Individuals with weak immune systems
• Long-term use of antibiotics

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Bleb Associated Endophthalmitis? (Etiology)

• Bleb Associated Endophthalmitis (BAE) is an infection that develops secondary to trabeculectomy surgery to treat glaucoma
  • The most common microorganisms causing infection are Staphylococcus epidermidis, Streptococcus sp., and Hemophilus influenzae
  • Other less common bacteria include Enterococcus, Pseudomonas, and other Staphylococcus sp.
• The factors that may increase the risk for infection include the surgical approach, intraoperative and postoperative treatments, and other complications such as bleb leakage
• A host of other contributory factors have been reported for Bleb Associated Endophthalmitis, such as eye and upper respiratory infections, diabetes, and poor immunity

In some individuals, BAE develops from a lack of recognition and/or treatment of blebitis.

What are the Signs and Symptoms of Bleb Associated Endophthalmitis?

The signs and symptoms of Bleb Associated Endophthalmitis may include:

• Severe eye pain
• Eye redness and tearing
• Eye irritation
• Blurred vision
• Sensitivity to light
• Discharge from the eye
• Inflammation of the conjunctiva
• Severely reduced vision
• Sensation of foreign body in the eye
• Decreased intraocular pressure or hypotony

The rate of progression of the condition is faster than what is noted with blebitis.

How is Bleb Associated Endophthalmitis Diagnosed?

Bleb Associated Endophthalmitis may be diagnosed by the following observations and tests:

• Physical examination and medical history evaluation (including history of eye surgery for glaucoma)
• Assessment of signs and symptoms
• General eye exam to check for post-surgical complications
• Fundoscopic (ophthalmoscopic) examination by an eye specialist, who examines the back part of the eye (or the fundus)
• Visual acuity test using a special and standardized test chart (Snellen chart)
• Slit-lamp examination
• Culture of eye scrapings to determine presence of the bacteria; a culture of the vitreous fluid is typically positive for causative bacteria
• Slit-lamp examination
• B-scan ocular ultrasonography and ultrasound biomicroscopy (UBM)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Bleb Associated Endophthalmitis?

The complications of Bleb Associated Endophthalmitis may include:

• Severe infection involving other eye structures such as the retina; a rapid course of infection is observed
• Permanent blindness
• Complications from treatment of the infection
• Decreased quality of life

How is Bleb Associated Endophthalmitis Treated?

Presently, there are no well-established treatment regimens for Bleb Associated Endophthalmitis. However, the treatment may involve the following measures:

• Administration of topical fortified antibiotics
• Hospitalization is necessary with intravenous administration of antibiotics (broad-spectrum antibiotics)
• Pars plana vitrectomy (PPV), a form of vitreoretinal surgery
• Topical or intravitreal steroids

Regular (daily) follow-up visits as advised by the eye expert/ophthalmologist.

How can Bleb Associated Endophthalmitis be Prevented?

Currently, there are no preventive measures for Bleb Associated Endophthalmitis. But an early recognition and treatment of this potential complication will help prevent vision loss.

• Individuals with certain pre-surgical eye conditions may need to be made aware of surgical risks and complications
• Healthcare providers are informed to adhere to best medical practices while performing glaucoma filtration surgeries
• Undertake prompt treatment of any eye conditions and other infections
• Seek treatment for underlying medical conditions that may reduce immunity
• In general, follow good hygiene practices

Close follow-up is recommended to evaluate treatment response and prevent any further post-surgical complications.

What is the Prognosis of Bleb Associated Endophthalmitis? (Outcomes/Resolutions)

• The prognosis for Bleb Associated Endophthalmitis is mostly poor, despite aggressive treatments
• Permanent eye damage and vision loss is observed in nearly 95% of the individuals

Additional and Relevant Useful Information for Bleb Associated Endophthalmitis:

Please visit our Eye & Vision Health Center for more physician-approved health information:

https://www.dovemed.com/health-topics/vision-center/