To reduce toxic anterior segment syndrome (TASS) after cataract surgery, what strategy should an IP recommend?

• A. Use preservative-containing medications
• B. Increase antibiotic dosing
• C. Use preservative-free medications
• D. Use colored dyes in solutions

Answer: (C)

TASS is a rapid, noninfectious inflammatory reaction of the anterior chamber caused by chemical toxins introduced during cataract surgery. The most effective prevention is to use preservative-free medications for intraocular use and in irrigating solutions. Preservatives such as benzalkonium chloride can be toxic to the corneal endothelium and other anterior segment tissues when they enter the eye, triggering TASS. Removing this source of chemical exposure by using preservative-free formulations greatly lowers the risk. Alternatives like simply increasing antibiotic dosing don’t address the toxin responsible for TASS, and dyes can add their own toxicity risk, so they aren’t the right preventive strategy.