Management of trauma-induced anterior necrotizing scleritis in a high-risk occupational setting: resolution with temporary tarsorrhaphy

Abstract

Objective: This case report highlights the challenges and innovative treatment approaches for managing trauma-induced anterior necrotizing scleritis (ANS), particularly in high-risk occupational settings, such as welding. Methods: We present the case of a 44-year-old male welder who suffered a metal particle injury in his right eye, leading to ANS. Initial treatments included removal of the foreign body, suturing of the conjunctival tear, and administration of antibiotics and hydrating eye drops. Subsequent treatments for the ensuing ANS included systemic and topical steroids, cyclosporine drops, oral prednisone, vitamin C supplements, dura and amniotic membrane grafting, and autologous serum eye drops. Following the failure of these interventions, a temporary tarsorrhaphy surgery was performed. Results: Despite the application of various conventional therapies, the patient’s condition did not improve significantly until temporary tarsorrhaphy was performed. This intervention, along with an intensive therapeutic regimen, led to the complete healing of the sclera and improved visual acuity. Conclusion: This case underscores the complexity of treating ANS, especially in cases resistant to standard treatment modalities. The successful use of temporary tarsorrhaphy in conjunction with other treatments highlights the need for an individualized approach to manage such conditions. This case contributes to the growing body of evidence suggesting the potential benefits of revisiting traditional surgical interventions for treating refractory cases of ANS. © 2025 Elsevier B.V., All rights reserved.