Pinpointing a leaky bleb with a blue surgical skin marker

We document a new technique to identify the site of leak from the entry point following bleb needling using a surgical skin marker. A 67-year-old man with advanced glaucoma in the right eye underwent trabeculectomy followed by bleb needling for subconjunctival fibrosis. Subsequently, he developed a bleb leak from the needling entry point with an intraocular pressure of zero mmHg. Despite pressure bandage application for 24 hours, the posteriorly located leak persisted. Suturing of the leakage point was recommended due to persistent hypotony. During surgery, the leakage points were not visualized. We stained the conjunctiva with a surgical skin marker at the suspected leakage site, which highlighted two closely situated openings and facilitated accurate suture placement. Complete closure of the leaks was achieved, resulting in an elevated bleb postoperatively. This is a simple and inexpensive method to identify the site of a leaking bleb under a microscope.