Multifocal Surgically Induced Necrotizing Scleritis Following Strabismus Surgery: A Case Report

Abstract

To present clinical findings of a 28-year-old woman with multifocal surgically induced necrotizing scleritis following uncomplicated strabismus surgery. A 28-year-old woman underwent uncomplicated strabismus surgery of her right eye for sensory exotropia under general anesthesia (6 mm right medial rectus muscle resection and 8 mm right lateral rectus muscle recession). Retrospective, observational case report and literature review. One month after strabismus surgery, the patient presented with surgically induced necrotizing scleritis in the nasal aspect of sclera. Bacterial culture of the bed of the scleral melt showed no growth and all laboratory evaluation was normal. The scleritis completely resolved after initiation of systemic corticosteroids and oral azathioprine. Three weeks later (after tapering dose of systemic medication), the patient returned with large area of necrotizing scleritis in the same eye, but this time in the temporal aspect of sclera. To our knowledge, this is the first documented case of multifocal surgically induced necrotizing scleritis occurring after strabismus surgery. This study also highlights the fact that scleritis may recur even in an area distant from the site of surgery, despite initial control. It seems that maybe with a longer course of treatment it is less likely to recur, and tapering medications should be carefully managed.