Surgically induced necrotizing scleritis after orbital surgery with intraconal tumor excision: a case report

Surgically induced necrotizing scleritis (SINS) is a blinding ocular disease characterized byinfl ammation with scleral necrosis. It occurs as early as one day after ocular surgery, although it can also occur years later. Commonly, it occurs after pterygium and cataract surgeries CASE PRESENTATION: Here, we report a case of a 40-year-old woman with underlying diabetes mellitus whounderwent a successful excisional biopsy via a swinging upper eyelid approach with lateral canthotomy andcantholysis, along with disinsertion of the superior and lateral rectus muscles, for an orbital cavernous venousmalformation. However, 9 weeks postoperatively, the patient developed persistent pain in the right eye (RE),especially with lateral gaze, which was not relieved with oral ibuprofen. At 16 weeks postoperative, an RE focal areaof scleral necrosis with surrounding conjunctival injection was noted at the superotemporal bulbar region. Magneticresonance imaging of the orbit and brain revealed RE focal thickening at the posterolateral sclera, posterior to thelateral rectus muscle insertion, suggesting posterior scleritis. The patient was treated with oral prednisolone (40mg/day) followed by a tapering regimen with adjunctive methotrexate (20 mg/week). After three months of oralprednisolone and six months of methotrexate, her disease resolved with no complications.

SINS is a rare but potentially sight-threatening complication following orbital surgery with intraconaltumor excision. Persistent pain can be a useful clue before the clinical signs become apparent.