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Antibiotic use, patient participation could help prevent blebitis
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HONG KONG — Early diagnosis, immediate medical treatment and patient awareness could aid in the prevention and treatment of blebitis, a glaucoma expert said.
Kuldev Singh, MD, MPH, spoke about his infection prevention and treatment regimen at Glaucoma Subspecialty Day, held before the World Ophthalmology Congress here. He said he urges his patients with blebs to practice good hygiene, to avoid wearing contact lenses and to take topical antibiotics when traveling in case of an ocular infection.
One of the most effective ways to prevent blebitis is to encourage common sense practices among patients, Dr. Singh said. He said he educates his patients to be proactive in seeking treatment for any suspected infection.
"This is something you should discuss before surgery because it's important for patients to know before they have a trabeculectomy that they will be at an increased risk of infection for the rest of their life," Dr. Singh said.
He also emphasizes the immediate use of antibiotics in eyes that show the first symptoms of infection.
"Infectious disease specialists hate this because they feel that overuse of these drugs results in more resistant organisms," he said. "But if you're a glaucoma specialist, if you're worried about infections, you take what you have, and you treat it." Risk factors are numerous, Dr. Singh said. Two risk factors involve a bleb: bleb leak and inferior bleb. Others include antifibrotic use, bacterial conjunctivitis, blepharitis and contact lens wear.
He is especially adamant about advising patients to not wear contact lenses. He marks their charts with this information but knows that he cannot control what they do once they leave his office, he said.
"There are some patients who insist on wearing contact lenses, but I never recommend contact lens wear in patients who have a bleb," Dr. Singh said.
To determine if blebitis has occurred, he said physicians should examine the bleb for leaks. In addition, he recommended conducting a thorough examination of the anterior chamber for inflammatory cells.
If blebitis is found and has infected only the bleb and anterior chamber, Dr. Singh said he prescribes topical and oral antibiotics with daily follow-up. In some cases, he has patients visit his office for a second evaluation soon after.
He places patients on topical cycloplegics and steroids after the initial antibiotic treatment. After the infection has cleared, he performs a bleb closure.
If the blebitis has spread to the posterior chamber, Dr. Singh said options for treatment are topical, oral and intravitreal antibiotics, a vitrectomy and changing antibiotics to the cultures found in the infection.