Localized, Extreme Scleral Thinning Causing Globe Rupture During Strabismus Surgery

Eye muscle surgery in strabismus patients usually is without serious, vision-threatening complications. The risk of scleral perforation during strabismus surgery has been reported to approximately 1% but usually without serious sequelae. 1,2 Inadvertent perforation may occur during muscle disinsertion or during muscle reattachment. The risk of perforation is increased in myopic eyes, 3 and the risk is higher in recessions than in other strabismus procedures. 4 We report a case of sudden rupture of the globe during a recession procedure on the superior rectus muscle caused by a localized area of extreme scleral thinning adjacent to the muscle insertion. To our knowledge, this serious complication has not previously been reported.