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Infection and Inflammation following Strabismus Surgery

Correspondence: Requests for reprints should be addressed to: David T. Wheeler, M.D., Casey Eye Institute, 3375 SW Terwilliger Blvd., Portland, OR 97239–4197.

Strabismus surgery is generally regarded as a relatively safe procedure, with the greatest risk to the patient often being that associated with anesthesia. However, as with all surgical procedures, postoperative complications do occur in a minority of patients.

Both acute and chronic inflammatory reactions are reported, most commonly to topical antibiotics or absorbable suture material. These events cause pain and conjunctival hyperemia but do not often threaten visual function except in the very rare case of necrotizing scleritis. Most cases of inflammation resolve spontaneously or with the use of topical steroid or non-steroidal medication. It is very important to consider the possibility of infection when managing these patients.

Postoperative infection is less common but more serious, carrying the threat of permanent visual impairment from endophthalmitis. Although most often associated with intraoperative scleral perforation, other sources of infection have been cited, including localized suture abscess formation. Orbital cellulitis also occurs infrequently, but can progress to cavernous sinus thrombosis and even death in young children. Suspected infection following strabismus surgery should prompt urgent evaluation and aggressive treatment.

Key words: endophthalmitis, infection, inflammation, strabismus surgery