Conjunctival necrosis due to periocular clear steroid injection mimicking scleral nodule

Abstract

Conjunctival necrosis with or without scleritis is a rare complication following periocular administration of corticosteroids. A 60-year-old lady presented with a diffuse scleral nodule with an overlying sinus in her left eye following cataract surgery. Tests for immune and infective etiology were negative. Due to its recalcitrant nature despite scraping, antibiotic, and steroid treatment, she underwent a scleral biopsy of the affected area, which was negative for organisms. However, high-pressure liquid chromatography with photodiode array detector revealed a significant presence of dexamethasone in the biopsy samples, which was the possible cause of conjunctival necrosis and ulceration mimicking scleritis.