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Trap-door
- A bleb is a trap-door that allows fluid to drain out of the eye to reduce the pressure inside the eye, which in turn helps treat your glaucoma.
www.moorfields.nhs.uk/ae/patient-guides/bleb-related-infection
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What is a bleb in glaucoma?
What is blebitis & bleb related endophthalmitis?
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How is bleb related endophthalmitis treated?
Can bleb related endophthalmitis cause glaucoma surgery?
What is bleb-related infection after glaucoma surgery?
A bleb is a trap-door that allows fluid to drain out of the eye to reduce the pressure inside the eye, which in turn helps treat your glaucoma. Sometimes, infection can occur at the place you were operated on. There are two main types of infection, called ‘blebitis’ and ‘bleb related endopthalmitis’.
Mar 15, 2003 · A high index of suspicion and attention to the early signs and symptoms of bleb-related infections can help prevent the potentially devastating consequences of a delayed diagnosis of bleb-associated infection.
- Introduction
- Blebitis
- Bleb Leakage
- Bleb Associated Endophthalmitis
- Summary
Bleb related infections (BRI) are a common problem and will be encountered by both comprehensive ophthalmologists and glaucoma specialists alike. BRI may develop days to years after surgery and can be a devastating complication of glaucoma filtering surgery leading to permanent visual loss. BRI are categorized as early-onset BRI when infection deve...
Background
The term blebitis was introduced in 1994 by Brown et al. to describe a presumed infection in or around a filtering bleb without vitreous involvement; it could be associated with mild to moderate anterior chamber (AC) reaction. Clinically, it refers to a limited form of infection around or inside a filtering bleb, often with an associated anterior chamber reaction and even hypopyon. Multiple factors have been identified as risk factors for BRI such as flat AC, early wound leak, thin bleb, woun...
Risk factors for blebitis
1. Bleb leak 2. Thin bleb 3. Wound manipulation 4. Limbus-based (rather than fornix-based) approach 5. Hyperlipidemia 6. Intraoperative and postoperative use of antimetabolites 7. Axial myopia 8. Young age 9. Conjunctivitis and blepharitis 10. Upper respiratory infection 11. Winter season
Bleb leakage has been shown to increase the risk of bleb infection 26 fold. Most believe that BRI begin secondary to bleb leakage, which allows bacteria from the tear film and the periocular structures access into the eye. However, it is also possible that a bleb infection may lead to breakdown of the bleb wall and subsequent leak. Early leakage is...
Background
If inflammatory or infectious material in a blebitis extend beyond the anterior chamber, the diagnosis is bleb associated endophthalmitis. BAE can have a clinical presentation similar to blebitis, except that the vitreous is involved. A positive vitreal culture is pathognomonic for BAE. While variable, the reported incidence of BAE ranges from 0.2% to 3.8%. The risk factors for BAE and blebitis are similar and numerous, including bleb leakage and the use of anti-metabolites. Inferior blebs ar...
Risk factors
1. Bleb leak, thin bleb, inferior or nasal bleb, high bleb 2. Intraoperative MMC 3. Limbus-based (rather than fornix-based) approach 4. Hypotony 5. Conjunctivitis 6. Upper respiratory infection 7. Blepharitis 8. Diabetes 9. Trabeculectomy alone compared to combined procedure 10. Chronic antibiotic use
Clinical Findings
In addition to the findings noted above for blebitis, patients with BAE often have more robust conjunctival inflammation and hyperemia, as well as more severe pain, markedly decreased vision, and accelerated course. Vitreal inflammation in a patient with a bleb infection is BAE until proven otherwise (Slide 4). B-scan may show vitreal involvement if there is no view of the retina on exam. Bleb leak may or may not again be present at the time of presentation due to plugging of the leak with in...
Bleb related infections are common; early diagnosis and treatment are crucial to provide the best chance for an optimal visual outcome.Blebs should routinely be assessed for leakage by Seidel testing, and leaks managed appropriately to prevent further complications.Leaks, thin/avascular blebs, the use of anti-metabolites, and blepharitis/conjunctivitis are the major risk factors for infectious complications of filtering blebs.Although no clear guidelines have been developed regarding management of BAE, early aggressive treatment is associated with better visual prognosis. Further, the results of the EVS cannot be reliab...Defined as mucopurulent infiltrate identified within a bleb, blebitis can be associated with mild-to-moderate inflammation of the anterior segment (Figure 1). The diagnosis changes to bleb-related endophthalmitis once one of the following is present: a hypopyon; cells in the anterior vitreous; or culture-positive aqueous or vitreous humor biopsy. 3
May 20, 2024 · Treatment for glaucoma typically involves lowering intraocular pressure through medication, laser therapy, or surgery. A bleb is a small fluid-filled blister that forms on the surface of the eye after glaucoma surgery and serves as a drainage site for excess fluid.
Sep 3, 2008 · A blebitis is defined as a mucopurulent infiltrate of a bleb. There can be associated mild to moderate anterior segment inflammation as part of a blebitis.
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