Blebitis Management: A National Survey and Literature Review

Abstract

INTRODUCTION: Filtering surgeries remain a cornerstone in the management of glaucoma. Although rare, blebitis represents a potentially severe complication that can compromise both surgical success and visual prognosis if not recognized and treated promptly. Management strategies vary widely, and no formal guidelines currently exist to direct therapy. In this context, the present study combines a brief literature review with a national survey to provide an updated overview of blebitis and to evaluate current trends in its management among glaucoma specialists in Portugal.

METHODS: An anonymous online survey consisting of 12 questions regarding the diagnosis and management of blebitis was distributed to glaucoma specialists in Portugal. The questionnaire addressed hospital admission, microbiological sampling, topical and systemic antibiotic use, corticosteroid and cycloplegic prescription, as well as criteria for addressing these cases as endophthalmitis. Responses were analyzed descriptively to identify patterns of practice and heterogeneity in management approaches. In parallel, a narrative review of the literature was conducted to summarize current evidence on incidence, risk factors, and therapeutic strategies.

RESULTS: A total of 33 responses were collected. Only 15.2% of glaucoma specialists reported admitting patients with isolated blebitis for inpatient treatment. Regarding antibiotic therapy, all specialists initiated topical treatment, with 72.7% preferring fortified eye drops containing ceftazidime and vancomycin. A minority opted for additional routes of antibiotic administration: intravitreal in 12.1%, subconjunctival in 9.1%, and intravenous in 6.1% of cases. Most specialists prescribed topical cycloplegics (75.8%) and topical corticosteroids (90.9%), although only 16.7% initiated corticosteroids at the time of diagnosis. Among respondents, 39.4% reported that they would only consider treating blebitis as endophthalmitis in the presence of vitreous involvement.

CONCLUSION: This combined literature review and national survey highlight significant variability in the management of blebitis among Portuguese glaucoma specialists, reflecting the absence of standardized guidelines. The findings underscore the need for consensus-based recommendations that may harmonize management strategies, improve patient safety, and optimize visual outcomes in this rare but sight-threatening complication.