Trigeminal sensory neuropathy developing as a late complication after the treatment of surgically induced necrotizing scleritis following pterygium surgery: a case report and literature review.

Abstract

Background: Surgically induced necrotizing scleritis (SINS) is an immune-mediated disease that occurs infrequently after ocular procedures, with latency ranging from days to years. There are various early and late complications that can negatively affect quality of life after SINS. This case report aims to present late trigeminal sensory neuropathy (TSN), corresponding in this patient to painful post-traumatic trigeminal neuropathy (ICHD-3 13.1.2.3), as a complication in a patient who developed SINS after pterygium surgery (PS).

Case presentation: A 31-year-old woman was admitted to our clinic for cosmetic surgical removal of bilateral pterygium. She had an unremarkable medical history. Following the 10th postoperative day in the right eye, the patient complained of eye irritation, visual impairment, and hypersensitivity to light. On biomicroscopic examination, the conjunctival autograft on the sclera had melted, and a choroidal reflex was visible. A multi-layered amniotic membrane graft was applied to the erosion during our initial repair; however, the graft deteriorated within one week. Conjunctival covering surgery with a pericardial patch was performed on the patient's area of scleral melting. Rheumatological evaluation was unremarkable, with no evidence of an underlying systemic disease. The patient, who had been undergoing systemic pulse steroid treatment and topical cyclosporine/steroid treatment for scleritis, was diagnosed with painful post-traumatic trigeminal neuropathy in the neurology department 3 months after her third surgery. This diagnosis was based on persistent symptoms (photophobia, dental pain, and headache) that did not respond to systemic and topical treatments for SINS. The patient who was treated for TSN responded to oral gabapentin treatment.

Conclusion: To the best of our knowledge, this is the first report of painful post-traumatic trigeminal neuropathy as a late complication of SINS following pterygium surgery. Physicians should consider this diagnosis in patients with persistent neuropathic pain after SINS.