No clutter, no confusion — just tap and play. Improved surgical techniques have led to an increase in the number of outpatient ophthalmic procedures. In spite of decreased surgical times and overall improved outcomes, endophthalmitis remains one of the most severe complications of ophthalmic surgery. Although there are well known risk factors tash71 for postoperative endophthalmitis, some prophylaxis strategies remain controversial. A category of noninfectious postoperative inflammation, known as toxic anterior segment syndrome (TASS), is a rare but important complication of cataract surgery.

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On exam, best corrected visual acuity was 1/200 with an intraocular pressure of 10 mmHg. Slit lamp examination revealed diffuse Descemet’s folds and limbus to limbus corneal edema (Figure 1A). The anterior chamber exhibited a 4+ inflammatory cell reaction without hypopyon (Figure 1B). The intraocular lens appeared centered with trace fibrin on the anterior surface.

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Proper cleaning of surgical instruments and sterilization remain important for reducing rates of TASS (102). When povidone-iodine cannot be used for cataract surgery (although true allergy is rare), the use of topical chlorhexidine gluconate may be considered, although this agent may be toxic to the cornea (20,32). The TAS-20 is scored by summing the item scores. The total score can range from 20 to 100, with higher scores indicating a greater degree of alexithymia. Alexithymia is thought to be a risk factor for a number of mental and physical health problems, including depression, anxiety, cardiovascular disease, and chronic pain.

In the EVS, approximately 30% of patients were culture negative (21). TASS is a non-infectious postoperative inflammation that occurs most commonly after cataract surgery but also may occur following keratoplasty and posterior segment procedures (52-55). It was first described in 1980 when nine eyes with intraocular lenses containing residual polishing compound on their surface developed sterile hypopyon (56,57). The incidence of TASS is difficult to estimate as it is uncommon and manifests both sporadically and in clustered outbreaks. The incidence following cataract surgery is likely around 1 in 1,000 (1,58).

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