Surgically induced necrotizing scleritis after strabismus surgery - A case series

SINS is a severe inflammation of the sclera seen postoperatively, with a rapid, devastating course, leading to visual loss if not recognized timely and treated. It is attributed to be an immune-mediated process and is most commonly seen with collagen vascular diseases and autoimmune disorders. Here, we describe three cases of SINS seen in a single strabismus practice center over 14 years. All the cases had a history of previous strabismus surgeries, while Cases 2 and 3 had additional cataract surgery done simultaneously. All the cases presented with SINS in the early postoperative period. The first case was a pediatric patient of 7 years, while the second and third were elderly males with diabetes mellitus and psoriasis, respectively. All of them received systemic steroids for varied durations and improved subsequently. This case series highlights that SINS can occur in the early postoperative period, but prompt treatment could salvage vision. All the cases were noninfectious, with negative culture reports. All cases required long-term treatment with systemic steroids, with a final good outcome. Our case series highlights the early recognition and management of SINS, with emphasis on screening of associated systemic diseases in strabismus. Treatment of the underlying systemic is essential for successful outcomes. Ruling out infectious etiology in postoperative cases is mandatory. This phenomenon highlights the importance of meticulous surgery planning and execution, as well as vigilant postoperative monitoring to identify and manage any signs of necrosis, and to treat associated unrecognized comorbidities.