Blebitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Historical Perspective
- Blebitis was officially identified by Dr. R.H. Brown in 1994 to classify bleb-infection not associated with the vitreous.[1]
Classification
Pathophysiology
Causes
- Blebitis may be caused by bacterial infection, predominantly Staphylococcus aureus and strains of Streptococcus.[2]
- The occular bleb's predisposition to infection occurs due to exposure and vulnerability following a trabeculectomy to treat glaucoma.[3]
- Blebitis is a rare complication of trabeculectomy.
Differentiating Blebitis from Other Diseases
Epidemiology and Demographics
- From 2007-2011, the incidence of blebitis in the United States was approximately 550 per 100,000 individuals.[4]
Age
- Blebitis patients are usually younger, less than 40 years old.[5]
- Blebitis is also commonly seen in African American patients older than 40 years old and Mexican Americans older than 60 years old, due to the higher rates of incidence of the precursory glaucoma.
Gender
- Males are more commonly affected with blebitis than females.[6]
Race
- African-Americans are more commonly affected with blebitis than other races.[6]
- Inuit are more prone to blebitis due to the higher incidence of glaucoma.[7]
Risk Factors
- Common risk factors in the development of Blebitis include the following:[6]
- Undergoing trabulectomy for glaucoma
- Experiencing a bleb-leak
- Persistent use of anti-fibrotic topical agents
- Being male
- Being young
- Being African-American
- Experiencing recurrent bacterial conjunctivitis
- Inferior location of the filtering bleb
Screening
Natural History, Complications and Prognosis
Natural History
Complications
- Without treatment, a possible complication of blebitis is endophthalmitis.[8]
- Endophthalmitis is caused when the pathogen causing blebitis, previously limited to the bleb, spreads past the anterior chamber of the eye and into the vitreous body.
Prognosis
- With treatment, the prognosis for blebitis is good.[9]
- Risk of permanent vision loss is minimal with effective therapy.
- Without treatment, the prognosis for blebitis is worse due to the increased risk of developing endophthalmitis.[2]
Diagnosis
Diagnostic Criteria
Symptoms
- Symptoms of blebitis may include the following:[10]
- Ocular pain of the filtering bleb
- Excessive sensitivity to light[11]
- Vision loss
- Intraocular pressure
- Fluid discharge[3]
Physical Examination
- Physical examination may be remarkable for:
- Hyperaemia in the affected eye
- Erythema of the affected eye due to presence of hypopyon[10]
- Thinning of the bleb epithelium
- Whitening of the bleb[1]
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
- The mainstays of therapy for blebitis are fortified topical antimicrobial and antibacterial agents:[12]
- Topical corticosteroids are often used in conjunction with antimicrobrial therapy.
Surgery
- Surgery is indicated for blebitis such that the bleb displays positive Seidel-test results for leakage.[12]
Prevention
References
- ↑ 1.0 1.1 Brown RH, Yang LH, Walker SD, Lynch MG, Martinez LA, Wilson LA (1994). "Treatment of bleb infection after glaucoma surgery". Arch. Ophthalmol. 112 (1): 57–61. PMID 8285894.
- ↑ 2.0 2.1 Wallin Ö, Al-ahramy AM, Lundström M, Montan P (2014). "Endophthalmitis and severe blebitis following trabeculectomy. Epidemiology and risk factors; a single-centre retrospective study". Acta Ophthalmol. 92 (5): 426–31. doi:10.1111/aos.12257. PMID 24020653.
- ↑ 3.0 3.1 Matsuo H, Tomita G, Araie M, Suzuki Y, Kaji Y, Obata H, Tanaka S (2002). "Histopathological findings in filtering blebs with recurrent blebitis". Br J Ophthalmol. 86 (7): 827. PMC 1771211. PMID 12084758.
- ↑ Vaziri K, Kishor K, Schwartz SG, Maharaj AS, Moshfeghi DM, Moshfeghi AA, Flynn HW (2015). "Incidence of bleb-associated endophthalmitis in the United States". Clin Ophthalmol. 9: 317–22. doi:10.2147/OPTH.S75286. PMC 4334336. PMID 25709395.
- ↑ "Facts About Glaucoma | National Eye Institute".
- ↑ 6.0 6.1 6.2 Soltau JB, Rothman RF, Budenz DL, Greenfield DS, Feuer W, Liebmann JM, Ritch R (2000). "Risk factors for glaucoma filtering bleb infections". Arch. Ophthalmol. 118 (3): 338–42. PMID 10721955.
- ↑ Cook C, Foster P (2012). "Epidemiology of glaucoma: what's new?". Can. J. Ophthalmol. 47 (3): 223–6. doi:10.1016/j.jcjo.2012.02.003. PMID 22687296.
- ↑ Ciulla TA, Beck AD, Topping TM, Baker AS (1997). "Blebitis, early endophthalmitis, and late endophthalmitis after glaucoma-filtering surgery". Ophthalmology. 104 (6): 986–95. PMID 9186440.
- ↑ Poulsen EJ, Allingham RR (2000). "Characteristics and risk factors of infections after glaucoma filtering surgery". J. Glaucoma. 9 (6): 438–43. PMID 11131749.
- ↑ 10.0 10.1 Brown, Reay H. (1994). "Treatment of Bleb Infection After Glaucoma Surgery". Archives of Ophthalmology. 112 (1): 57. doi:10.1001/archopht.1994.01090130067019. ISSN 0003-9950.
- ↑ Feldman, Robert (2013). Complications of glaucoma surgery. Oxford: Oxford University Press. ISBN 978-0-19-538236-5.
- ↑ 12.0 12.1 Reynolds AC, Skuta GL, Monlux R, Johnson J (2001). "Management of blebitis by members of the American Glaucoma Society: a survey". J. Glaucoma. 10 (4): 340–7. PMID 11558820.