Late-onset bleb-associated endophthalmitis and continuous positive airway pressure

Purpose: To raise awareness of a possible association between continuous positive airway pressure (CPAP) devices and postoperative bleb-related infection. Observations: A 57-year old patient on CPAP presented with unilateral bleb-associated endophthalmitis 32 months after routine ExPress Trabeculectomy with mitomycin C. The offending organism, Streptococcus mitis, is a nonmotile and generally non-virulent pathogen which predominates in the normal human respiratory flora. Conclusions and importance: This conceptual report underscores a potential relationship between CPAP use and bleb-associated endophthalmitis. Streptococcal species are the most commonly reported causative organisms in bleb-associated endophthalmitis, and S. mitis is of particular concern as the most abundant microbe among all human oral flora. A logical risk factor for infection, the CPAP device may inadvertently deliver such organisms to the vulnerable conjunctival filtering bleb. Keywords: Endophthalmitis, Bleb, Mitomycin C, Express trabeculectomy, Continuous positive airway pressure, Streptococcus miti