INTRODUCTION
Corticosteroids are commonly employed during ophthalmic surgery to
manage postoperative inflammation and avoid complications. Sub-Tenon
triamcinolone injection have been a favored approach to managing ocular
inflammation as they deliver focal anti-inflammatory effects with
minimal systemic side effects (1). Though widely practiced, adverse
reactions of triamcinolone injection, more specifically scleral
necrosis(2), are rare and poorly reported, more so in pediatric
cases.Conjunctival necrosis and ischemia due to periocular/intraocular
administration of methylprednisolone, triamcinolone acetonide, and
betamethasone were already noted in adult patients (3, 4,5).
Scleral necrosis is a severe complication that can cause progressive
thinning of the sclera, tissue loss, and, in some cases, perforation.
Scleral necrosis has largely been related to systemic autoimmune
diseases, infectious etiologies, and prior ocular surgeries. Yet,
localized scleral necrosis after corticosteroid injections has been
described, with possible mechanisms being direct cytotoxicity of the
drug or its preservatives, localized ischemia secondary to
steroid-induced vasoconstriction, and mechanical trauma from the
injection process itself (6). Drug-induced scleral necrosis is an
underdiagnosed condition, with few reported cases after corticosteroid
injections. In adult patients, localized scleral necrosis has been
reported following subconjunctival or periocular steroid injections in
patients with predisposing conditions like prior surgery or impaired
ocular vasculature (7).
Most of the reported cases are adults with pre-existing predispositions,
but cases in pediatric patients continue to be very rare, and this
raises fears regarding possible variations in scleral susceptibility and
healing patterns in children (8). Benzyl alcohol experiments have been
shown to disrupt the epithelial cell membrane and initiate the process
of apoptosis and its resultant delayed healing effects along with
inflammation at the wound site.(9)
Such an instance has been reported in a child who had undergone the same
procedure and developed conjunctival necrosis due to the application of
triamcinolone acetonide into her eye through a subconjunctival route for
chronic, severe anterior uveitis. This also exists in a child with
conjunctival necrosis after performing subconjunctival injection of
triamcinolone acetonide for chronic severe anterior uveitis (8).