Necrotizing Conjunctival Ulceration following Subconjunctival Atropine Depot Injection

ABSTRACT

PURPOSE: To report a case of severe conjunctival necrosis associated with scleral melting following subconjunctival atropine depot injection in treating posterior synechiae associated with uveitis. METHODS: A 31-year-old male patient visited our clinic after subconjunctival injection of 1% atropine, 0.4 ml, in treating circular posterior synechiae associated with uveitis in his left eye. The marked conjunctival injection and chemosis around the limbus were noted. Three days after first visit to our clinic, remarkable necrosis had developed around the whole limbus, and newly developed whitish necrotic tissue was noted over sclera and episclera. We debrided the necrotic conjunctiva and episclera, and the exposed sclera was grafted with amniotic membrane. REUSLTS After 4 weeks, the complete re-epithelization of necrotized defect was shown and there were no evidence of inflammation, symblepharon, or scleral melting. CONCLUSIONS: In usage of atropine, especially to eyes locally, subconjunctival injection should be avoided due to direct toxicity to the conjunctiva and sclera to form necrosis and melting. The damaged lesions of conjunctiva and sclera due to usage of this drug generally cause chronic inflammation and persistent surface defect. In order to restore and re-epithelize the necrotic defect, more aggressive treatment such as an amniotic membrane transplantation would be needed.