**3. Symptoms and signs of bleb related infection**

BRI can lead to severe and permanent loss of vision if not detected and treated in a timely and directed manner. Early on there may be mild signs similar to viral or bacterial conjunctivitis, leading to a delay in seeking medical attention. Cases typically present with a painful red eye, often associated with discharge, eyelid swelling, photophobia, and reduced vision. There may be a prodromal history of headache, conjunctivitis, blepharitis, and coryza [17].

The findings include a milky bleb appearance due to a mucopurulent infiltrate. There is usually swelling and hyperaemia of the conjunctiva with upper eyelid oedema. These findings are known as a "white on red" appearance (**Figure 1**). The anterior chamber may be shallow if there is a bleb leak. Later on, an anterior chamber inflammatory reaction occurs, and anterior vitritis.

Generally, BRE and blebitis present similarly, but the symptoms and signs in BRE are more fulminant with greater reduction in vision and a more accelerated course.

**Figure 1.** *"White on red" appearance of bleb related infection (notice adjacent blepharitis).*

In the author's experience, blebitis can progress to BRE very rapidly, so that if suspected, there must be a low threshold to admit the patient immediately for appropriate targeted treatment (vide infra).
