ESCRS - POCAT141 - Toxic Anterior Segment Syndrome: When A Routine Cataract Surgery Turns Into An Ocular Emergency

Toxic Anterior Segment Syndrome: When A Routine Cataract Surgery Turns Into An Ocular Emergency

Published 2026 - 44th Congress of the ESCRS

Reference: POCAT141 | Type: Poster | DOI: 10.82333/0ef8-hm93

Authors: Dr Meryem Benkirane* 1 , A/Prof. Youness Hidan 1 , A/Prof. Leila benhmidoune 1 , A/Prof. riyad rachid 1

1Hospital 20 aout,Casablanca,Morocco

Purpose

Toxic Anterior Segment Syndrome (TASS) is an acute, sterile inflammation of the anterior segment occurring after intraocular surgery, most frequently cataract extraction. Unlike infectious endophthalmitis, TASS is triggered by toxic substances rather than pathogens. If not recognized and managed promptly, it can lead to permanent visual impairment. Early differentiation from infection is crucial for appropriate therapy and prognosis.

Setting

A patient underwent uncomplicated phacoemulsification with intraocular lens implantation. On postoperative day 1, she presented with:

  • Decreased visual acuity
  • Photophobia
  • Painless red eye

Slit-lamp examination revealed:

  • Marked corneal edema
  • Intense anterior chamber inflammation with cells and flare
  • Moderate hypotony
  • Absence of significant pain
  • Clear vitreous, no purulent hypopyon

These findings suggested a sterile process rather than infectious endophthalmitis.

Methods

A comprehensive clinical evaluation was performed including:

  • Slit-lamp biomicroscopy
  • Anterior segment OCT
  • Vitreous assessment

Perioperative protocols were reviewed to identify possible sources of toxicity:

  • Irrigation solutions (composition, dilution, storage)
  • Sterile instrument cleaning and sterilization
  • Viscoelastic and anesthetic agents
  • Medication preparation and handling

Suspect solutions were cultured, sterilization procedures audited, and operating room practices re-evaluated.

Results

The patient presented with rapid-onset (<24 h), isolated anterior segment inflammation consistent with TASS. Topical corticosteroids and cycloplegics led to rapid resolution of corneal edema and recovery of visual acuity. Investigation revealed improper dilution of the irrigation solution as the likely cause, with no infectious agents detected.

 

Conclusions

TASS is an ophthalmic emergency. Prompt diagnosis and treatment with topical corticosteroids and cycloplegics can prevent permanent anterior segment damage. Strict adherence to irrigation protocols, sterilization procedures, and operating room hygiene is essential to prevent occurrence. Vigilance and awareness among surgeons and staff remain the most effective preventive measures.