A Rare Case: Toxic Anterior Segment Syndrome Without Corneal Edema

To discuss the importance of clinical findings and symptoms in the differential diagnosis of toxic anterior segment syndrome patients and their impact on treatment approach.

This was a case report and designed at Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

A 69 years old male patient presented with a complaint of decreased vision. His medical history included diabetes and coronary artery disease. The patient underwent uncomplicated phacoemulsification surgery. On the first day postoperatively, his vision was 0.05 according to snellen chart, ocular pressure was 16 mmHg. +4 cells in the anterior chamber and 2 mm hypopyon, and a fibrin membrane were observed on his anterior segment slit lamp examination. There was no vitritis on ocular USG imaging. The patient had minimal pain and no discharge.

Postoperative endophthalmitis and toxic anterior segment syndrome were considered in the differential diagnosis. Due to the absence of pain and discharge in the patient, and the onset of symptoms within 16 hours postoperatively, toxic anterior segment syndrome was suspected.

The patient was started on hourly tropical moxifloxacin, prednisolone, and tropicamide drops after being diagnosed with toxic anterior segment syndrome. A subconjunctival dexamethasone injection was also administered.

On the second day postoperatively, it was observed that there was regression in the patient's hypopyon and the fibrin membrane had disappeared. The resolution of the membrane with treatment supported the accuracy of the diagnosis.

On the fourth day of treatment, the patient's hypopyon disappeared. The anterior chamber cell count decreased to +2 cells. The patient's vision improved to a level of 0,8 according to snellen chart.

Toxic anterior segment syndrome is a rare complication that can occur after cataract surgery. It is usually accompanied by corneal edema that extends from the limbus to limbus. It occurs in the acute phase after the operation.

Confusing toxic anterior segment syndrome with postoperative endophthalmitis and treating patients with an endophthalmitis diagnosis may lead to unnecessary invasive procedures and negatively affect the visual prognosis. Therefore, a clear distinction must be made between the two conditions.