Two cases of toxic anterior segment syndrome from generic trypan blue

We report 2 cases of toxic anterior segment syndrome (TASS) resulting from impurities in generic trypan blue that was administered intracamerally to improve visualization of the capsule. Histology of the corneal buttons revealed foci of inflammatory response and complete loss of endothelial cells. Cell culture analysis showed that the generic trypan blue was approximately twice as toxic to the endothelium as a proprietary trypan blue. Ophthalmologists should be aware that any substance administered intraocularly can be a source of complications, and they should know the source of all material used in surgery.