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Ophthalmology · Glaucoma: blebitis after trabeculectomy
Sample itemTwo years after trabeculectomy, a patient has sudden pain, redness and reduced vision. The filtering bleb is opaque and milky with a hazy anterior chamber but no hypopyon. What is the most appropriate management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Intensive topical fortified broad-spectrum antibiotics
A white, infected bleb without vitreous involvement, blebitis, is treated urgently with intensive topical broad-spectrum antibiotics, and with systemic or intravitreal antibiotics if endophthalmitis develops. Delay risks spread into the vitreous. Steroids are added only after the infection is controlled.
Option by option
A. Laser suture lysis
Laser suture lysis is for tight early filtration, not an infected bleb.
B. Topical steroid drops alone
Steroid alone would let the infection spread.
C. Observation with lubricants
Observation risks bleb-related endophthalmitis and loss of the eye.
D. Intensive topical fortified broad-spectrum antibiotics (correct)
Correct. Prompt intensive antibiotics contain the infection before it enters the vitreous.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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