Toxic anterior segment syndrome can usually be traced to a contaminant on an instrument, in a solution or associated with a topical medicine. It is important to identify the cause so additional cases can be avoided.
Source
Cause
surgical instrument
insufficient or improper cleaning; rinsing in sterilized tap water
irrigation solutions during surgery
endotoxin or other contaminant; reconstituting solutions with sterilized tap water
topical ophthalmic medications or ointments
endotoxin, chemical or other irritant
surgical gloves
talc or other surface contaminants
intra-ocular lens
contaminant
Problems during instrument preparation may include:
(1) use of wrong sterilizing solution (glutaraldehyde, other)
(2) contamination associated with a malfunctioning steam sterilizer
(3) improper cleaning for reusable cannulas
Things that can make the investigation easier:
(1) recording the lots of all items used in surgery
(2) having a test for endotoxin available
(3) identifying deviations from recommended guidelines
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