Treat blebitis immediately, surgeon says

DANA POINT, Calif. — Early diagnosis and immediate treatment are crucial for the effective management of blebitis, according to a surgeon speaking here.

Factors that increase the risk of developing blebitis include surgery in patients with an existing bleb, use of antifibrotics, inferior bleb location, bleb leaks, contact lens wear and blepharitis, said Kuldev Singh, MD, here at the Ocular Drug and Surgical Therapy Update meeting. Systemic risk factors include diabetes mellitus, malnutrition and a compromised immune system, he said.

The clinical presentation of blebitis is a milky, white bleb, Dr. Singh said. There may be conjunctival infection and hyperemia. Inflammation can spread to the anterior chamber and vitreous and cause hypopyon, he said.

On examination, look for leaks, examine the vitreous and use B-scan ultrasonography if the leak is not easily visualized, Dr. Singh advised. Also examine the anterior chamber and evaluate for inflammatory cells, he said. He said he uses vitreous cultures but not conjunctival or aqueous cultures to identify infectious agents. If staphylococcal or streptococcal species are present, “treatment must be immediate,” he said.

Treatment can include the administration of the newer fluoroquinolones, Dr. Singh said. He advocated erring on the side of caution, and he said he overtreats because of the potential for rapid spread of infection.

Fluoroquinolone administration with a suspected infection may be controversial, “but is done,” Dr. Singh said. Education of patients at risk is important, he said.