The sub-Tenon route for injecting triamcinolone acetonide is one of the widely practiced surgical techniques for postoperative inflammation control, but complicated conjunctival and scleral necrosis are rare occurrences. A 3-year-old boy underwent bilateral cataract surgery and an anterior sub-tendon injection of triamcinolone (AST) (20mg). One week later, he presented with conjunctival necrosis at the injection site and thinning of the sclera in both eyes. Necroses being unresponsive to conservative management led to surgical debridement and removal of residual steroid deposits. The conjunctiva healed well without grafting, and the patient remained stable at the six-month follow-up from the ocular point of view. This rare but serious complication of periocular steroid injection in a child demands cautious administration of steroids, prompt diagnosis of necrosis, and timely intervention to limit serious ocular morbidity.

Keywords : Sub-Tenon injection, triamcinolone acetonide, scleral necrosis, pediatric cataract, periocular steroids