Key Pre-Operative Points

           Scleral Melt following Pterygium Surgery
 
             Before Surgery                         After Surgery

If the patient does not have a clear underlying etiology such as acute chemical burn or use of beta irradiation or MMC for pterygium, known to cause scleral ischemia, and if the scleral melt is limited to the limbal and peripheral corneal regions (like peripheral ulcerative corneal diseases), it is advised to rule out whether there is a systemic collagen vascular disease caused by autoimmune dysregulation. An appropriate diagnostic work-up and consultation are needed. If verified, systemic immunosuppression should also be initiated. Mooren’s ulcer is a disease diagnosed after exclusion of these diseases.

Dellen formation due to insufficient tear flow or spread can cause scleral thinning or aggravate a scleral melt. Therefore, it is also important to determine whether there is neurotrophic keratopathy, aqueous tear deficiency (dry eye) or surface exposure due to infrequent blink and incomplete closure by checking corneal sensitivity, performing Schirmer test without anesthetics, and checking the blink rate. If noted, these problems should be managed first by punctal occlusion (to both upper and lower) with punctal plugs or even with permanent cauterization, followed by large scleral lens protection, pressure patch (temporarily), or tarsorrhaphy.

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