From the Guidelines
A bleb is a small, fluid-filled bubble or sac that forms on the surface of tissue, most commonly found on the eyes, and is deliberately created during glaucoma surgery to allow excess fluid to drain from the eye, reducing intraocular pressure. In the context of ophthalmology, blebs are a crucial aspect of glaucoma management, as they play a key role in regulating intraocular pressure 1. The formation of a bleb is a intended outcome of trabeculectomy, a surgical procedure used to treat glaucoma, and its success is closely monitored post-operatively to ensure proper drainage and to prevent complications such as bleb failure 1.
Key Characteristics of Blebs
- They are small, fluid-filled sacs that form on the surface of the eye
- They are deliberately created during glaucoma surgery to facilitate excess fluid drainage
- Their success is crucial for maintaining reduced intraocular pressure in glaucoma patients
- Post-operative care includes monitoring for signs of bleb failure, such as increased inflammation or Tenon’s cyst formation 1
Clinical Significance
Blebs can be associated with various complications, including bleb leak, early bleb failure, and the formation of Tenon’s cyst (encapsulated bleb) 1. Management of these complications may involve additional treatments such as injection of antifibrotic agents, bleb massage, or surgical intervention 1. The ophthalmologist's role in perioperative care, including preoperative evaluation, postoperative follow-up, and management of complications, is critical for the success of the surgery and the patient's quality of life 1.
Treatment and Management
Treatment of bleb-related complications depends on the nature and severity of the issue, ranging from conservative management with topical medications to more invasive procedures like bleb needling or revision surgery 1. The decision to intervene is guided by the clinical presentation and the potential impact on the patient's vision and quality of life. The primary goal is to maintain a functioning bleb that effectively regulates intraocular pressure, thereby preventing glaucoma progression and preserving vision.
From the Research
Definition of Bleb
- A bleb is a small, circumscribed collection of fluid in the skin, typically up to 1 cm in size 2.
- It can be subcorneal, intra-epidermal, junctional, or subepidermal, and may be filled with fluid or pus 2, 3.
Types of Blebs
- In the context of glaucoma-filtering surgery, a bleb refers to a blister-like formation on the conjunctiva, which can be microcystic, avascular, or vascular 4.
- In cell biology, a bleb is a protrusion of the cell membrane caused by actomyosin contractions, resulting in a transient detachment of the cell membrane from the actin cortex 5.
Clinical Significance
- Blebs can be a sign of various diseases, such as pemphigus, bullous pemphigoid, or epidermolysis bullosa 2, 3.
- In the context of glaucoma-filtering surgery, blebs can become infected, leading to blebitis, which can be caused by various microorganisms 4.
- Hemorrhagic bullae, a type of bleb, can be a sign of a life-threatening condition, such as necrotizing fasciitis 6.