PA PSRS Patient Saf Advis 2006 Dec;3(4):14.
Keeping an Eye on Toxic Anterior Segment Syndrome

Editor’s Note

The following information has been abstracted from the cover article of the December 2006 AORN Journal. PA-PSRS Clinical Analyst Janet Johnston, RN, MSN, JD, was invited to submit the article for publication. Additional resources have been provided.

Keeping an Eye on Toxic Anterior Segment Syndrome

Since June 2004, ambulatory surgical facilities have submitted at least 15 reports of toxic anterior segment syndrome (TASS) to PA-PSRS, and at least three facilities have reported multiple cases. TASS is a complication of intraocular surgery that occurs when a non-infectious toxic agent enters the anterior segment of the eye and causes an inflammatory reaction. While it is a rare complication, severe cases of TASS can cause permanent injury to the eye. Often, the cause of a TASS event remains unknown even after investigation, but potential causes identified in the clinical literature include bacterial endotoxin, viscoelastic, and other residues introduced into the eye (e.g., on instruments); solutions and intraocular fluids introduced into the eye; preservatives in ophthalmic solutions; medications that penetrate through surgical wounds in the eye; and intraocular lenses (i.e., design and composition).

TASS incidence is difficult to pinpoint for several reasons, including that TASS is often confused with and treated as infectious endophthalmitis. Symptoms (e.g., decreased or blurred vision, hypopyon, fibrin and conjuctival redness) are similar for both diagnoses—a complete evaluation conducted by an ophthalmologist will differentiate between the two. Such an examination comprises the following: fundus examination, gonioscopy, slit lamp examination, tonometry, and aqueous and vitreous needle examination. If early diagnosis of TASS is made, timely and appropriate intervention is effective. Treatments vary, but the most common treatment is administering corticosteroids to reduce inflammation. After treatment, careful monitoring and follow-up protects against further inflammation.

Risk-reduction strategies for clinicians, surgical team members, patients, and others to consider include the following:

  • Awareness
    • Acknowledging the potential for TASS to occur (e.g., quickly investigating and appropriately treating inflammation that occurs the day after surgery)
    • Being wary of all items introduced into the eye during surgery
    • During discharge, instructing patients to return at first indication of visual disturbance
  • Communication
    • Involving perioperative personnel in discussions about purchasing changes to avoid supply items associated with TASS
    • Discussing intraoperative changes that could contribute to TASS (e.g., intraoperative switch to different irrigating solution)
    • Documenting and recording medications, solutions, and instruments used in surgery to help identify patterns in the event of TASS outbreak
  • Technique
    • Considering techniques to reduce the risk of TASS discussed in clinical literature

Source: Johnston J. Toxic anterior segment syndrome— more than sterility meets the eye. AORN J 2006 Dec [cited 2006 Dec 6]. Available from Internet: http://www.aornjournal.org/article/PIIS000120920663994X/abstract.

Additional Resources

American Society of Cataract and Refractive Surgery

cme2 (an independent subsidiary of Advanstar Communications,Inc)

  • TASS: Probable Causes and Corrective Measures [Web site]. [cited 2006 Dec 8]. Available from Internet: http://www.tassfacts.com/.
PSA LOGO

The Pennsylvania Patient Safety Advisory may be reprinted and distributed without restriction, provided it is printed or distributed in its entirety and without alteration. Individual articles may be reprinted in their entirety and without alteration, provided the source is clearly attributed.

Current and previous issues are available online at http://patientsafety.pa.gov.