Case Report: Subconjunctival Triamcinolone Acetate-associated Scleral Necrosis: Is It Really Obsolete?

Area of Science:

• Ophthalmology
• Steroid Therapy
• Scleral Complications

Background:

• Subconjunctival steroids are generally considered safe for anterior scleritis.
• Previous studies have not identified scleral necrosis as a complication.

Observation:

• A 45-year-old male with refractory anterior nodular scleritis received subconjunctival triamcinolone acetate.
• Three weeks post-injection, the patient developed diffuse congestion and 10 clock hours of anterior scleral necrosis.
• Imaging revealed scleral outpouching and buckling; systemic workup was negative for autoimmune disorders or herpes zoster ophthalmicus.

Findings:

• The patient was diagnosed with subconjunctival triamcinolone acetate-induced scleral necrosis.
• Conservative management led to gradual improvement and complete resolution of the steroid depot over two years.
• No recurrence of scleritis or necrosis was observed during the follow-up period.

Implications:

• Scleral necrosis is a rare but potential complication of subconjunctival triamcinolone acetate.
• Judicious use of subconjunctival triamcinolone acetate is recommended for nonresolving anterior scleritis.
• Ophthalmologists should be aware of this risk and monitor patients closely.