Initial reports did not mention any specific etiology for TASS. Bacterial toxins are one of the recently proposed etiologies for TASS [10]. Endotoxins are lipopolysaccharides (LPS) produced by gram-negative bacteria and is a potent inflammatory mediator causing septic shock. The lipid A portion of the LPS molecule is thought to be responsible for this potent inflammatory effect. Endotoxin is heat stable and can readily survive short-cycle sterilization [11]. Bacteria such as Pseudomonas are killed by short-cycle sterilization (3.5 min at 180 °C), but their endotoxins are released from the cell walls in the sterilizer. These endotoxins remain biologically active and can be deposited on instruments used in the anterior segment (chiefly, cataract) surgery. Contaminated ultrasonic baths and cleaning detergent liquid has also been implicated [12]. Usage of postoperative ointments can cause the oily substance in the ointments to diffuse into the anterior segment and cause TASS [13].

The typical hallmark of TASS is an inflammatory process starting in the first 24-h post surgery. The inflammation is classically limited to the anterior segment of the eye. The inflammation in the anterior segment is severe and often results in hypopyon. Another common feature is limbus-to-limbus corneal edema. TASS diagnosis is clinical, and the clinical differentiating features are shown in Table 3.2. Absence of vitreous inflammation is the most significant difference between TASS and endophthalmitis. Three sight-threatening complications of TASS are intractable glaucoma, cystoid macular edema, and corneal decompensation (Fig. 3.1) [1].

The TASS cases are noninfective and respond very well to topical steroids. Clinical management hinges on early recognition based on the signs and symptoms as mentioned before. If the picture is unclear, the patient should be treated on the lines of infectious endophthalmitis. Once TASS is confirmed, the mainstay of treatment is topical corticosteroids. The usual regimen is one drop of topical corticosteroid every 30–60 min for the first 3 days with gradual tapering. The response is typically rapid with good improvement. The intraocular pressure should also be monitored closely.