Necrotizing scleritis after “pterygium” excision with mitomycin C

Purpose Application of Miitomycin C during pterygium excision is discussed to reduce its recurrence rate. Nevertheless, potential adverse effects of Mitomycin C application should be evaluated in each individual patient. Method We report on minimal invasive procedures applied in a case of scleral necrosis following pterygium excision combined with intraoperative application of Mitomycin C. A 87‐year old man presented for a second opinion having suffered a severe ocular pain on the left eye for the last three weeks after pterygium surgery. At presentation, a gradual thinning of the sclera spreading to the adjoining cornea was observed. In addition, signs of chronic blepharitis with a dysfunction of the marginal eyelid glands, as well as, a negative Bell’s sign were observed on both eyes. Results Local lubrication was applied, supported by broad‐spectrum local antibiotic therapy. In order to prevent perforation and strengthen the corneal stroma, doxycycline 100 mg daily, was added. The initiated systemic prednisone treatment was reduced to 20 mg daily. In addition, to support sufficient eyelids closure in the presence of negative Bell’s phenomenon, 20 units Botox was applied. Within the following days a gradual remission was achieved; with reduction of necrotic area and perilimbal ischemia, supporting thus, the corneal thickening and consequently the symptomatic pain release. Furthermore, histological results of the excised pterygium revealed conjunctival tissue with focal metaplasia of the squamous epithelium, stromal fibrosis, elastosis, and a small amount of conjunctival calcification, findings compatible with pinguecula on atypical location. Conclusion The presented case confirms that application of mitomycin C should be used with consideration in patients featuring pre‐existing trophic anterior segment disease and/or systemic disease predisposing to wound‐healing impairment.