Acute-onset surgically induced necrotizing scleritis after strabismus surgery

Area of Science:

• Ophthalmology
• Surgical Complications
• Inflammatory Diseases

Background:

• Surgically induced necrotizing scleritis (SINS) is a rare but severe complication following ocular procedures.
• It can manifest days to years post-surgery, presenting significant challenges in patient management.

Observation:

• A 32-year-old male developed SINS post-strabismus surgery for exotropia.
• The condition presented as painless scleral inflammation, choroidal exposure, and globe ectasia within days.
• Infectious or systemic inflammatory causes were ruled out through comprehensive work-up.

Findings:

• The patient's SINS demonstrated a rapid onset and characteristic clinical signs.
• Diagnostic work-up excluded infectious etiology and systemic inflammatory diseases.
• Treatment with oral immunosuppression alone led to complete clinical resolution.

Implications:

• This case highlights the importance of recognizing SINS as a distinct post-surgical complication.
• Successful management with immunosuppression alone suggests a non-infectious, possibly autoimmune, mechanism in some SINS cases.
• Avoiding surgical intervention like grafts simplifies treatment and improves patient outcomes.