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).