Toxic anterior segment syndrome presenting as isolated cystoid macular edema after removal of entrapped ophthalmic ointment

We report a case of ophthalmic antibiotic ointment in the anterior chamber following uneventful phacoemulsification surgery. Antibiotic ointment was observed in the superior angle beneath the clear corneal wound one month later. The patient remained asymptomatic for 26 months after surgery until mild iritis developed. The ointment was removed through a limbal incision superiorly via passive expression. Visual acuity declined to 20/200 after explantation on postoperative day one. Fluorescein angiography revealed cystoid macular edema. The treatment was refractory to topical steroid and non-steroid anti-inflammatory drugs, however responded well to intravitreal triamcinolone injection. Ophthalmic ointments may ingress into the anterior chamber through unstable clear corneal incisions. Although a globule of ointment may remain inert for a long time, its delayed extraction may be associated with cystoid macular edema.