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

## TL;DR

A 40-year-old woman with diabetes developed a rare eye condition called surgically induced necrotizing scleritis nine weeks after orbital surgery, which was successfully treated with steroids and methotrexate.

## Contribution

This case report highlights SINS as a rare but serious complication following intraconal tumor excision and emphasizes the importance of persistent pain as an early warning sign.

## Key findings

- Surgically induced necrotizing scleritis occurred 9 weeks after intraconal tumor excision in a diabetic patient.
- Persistent pain preceded visible scleral necrosis, indicating early detection is crucial.
- Treatment with prednisolone and methotrexate led to complete resolution of the disease without complications.

## Abstract

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

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.