I want to remind those of you who have had glaucoma surgery that it is very important that you are aware of the possibility of developing an infection in the filtering bleb that was created at your glaucoma surgery. The glaucoma operation creates an auxiliary “drain” on the outside of the eyeball, commonly called a filtering bleb. This bleb has direct communication to the inside of the eye.

Normally, the eyeball has a rather impervious wall around it, making it difficult for infectious agents to penetrate the wall of the eye. An infection inside the wall of the eye is called endophthalmitis.

The filtering bleb is a rather thin walled structure. In some cases the wall is extremely thin and intermittently even leaks fluid through it. This is not unusual in a person who has a very successful glaucoma operation. This thin walled bleb is a lot easier for bacteria to traverse and, thus, infection within the bleb can occur. This infection is called “blebitis.” It is usually associated with a rather red eye, a discharge, some pain and blurred vision.

The entire purpose of this article is to bring to your attention the possibility that this could occur. This requires immediate attention as, if blebitis occurs, it quickly can lead to endophthalmitis. Endophthalmitis commonly can cause severe loss of vision.

There are some general precautions to take if you have had glaucoma surgery and a bleb is present. It would be important not to get contaminated fluids in the eye such as poorly disinfected swimming pools, contaminated eye drops, dirt from your hands while instilling eye drops, etc.

Studies have been performed with prophylactic antibiotics used topically. These do not seem to be of any real benefit in preventing either the incidence or the severity of infected blebs. The incidence, however, is really not that high and, with careful attention to proper hygiene, and early intervention, the chances of having severe visual loss after filtering surgery can be minimized.

- Dr. Lawrence M. Hurvitz, MD