Strep pyogenes infection causing rapid onset orbital cellulitis, superior ophthalmic vein thrombosis, and necrotizing scleritis with dehiscence of extraocular muscle following strabismus surgery.

PURPOSE: To report an infrequent but potentially devastating complication following strabismus surgery and its approach to management.

OBSERVATIONS: A 5-year-old girl underwent bilateral medial rectus recessions for esotropia. She quickly developed progressive orbital cellulitis that was confirmed on computed tomography along with non-occlusive thrombosis of the superior ophthalmic vein. She was treated with intravenous antibiotics, additional surgery (which found a dehisced medial rectus muscle), and anticoagulation. Cultures grew Streptococcus pyogenes (Group A). Ultimately the patient made a full recovery.

CONCLUSION AND

IMPORTANCE

Although orbital cellulitis is a known complication following strabismus surgery, surgeons should be aware of additional secondary complications that can occur and have a low threshold for imaging and repeat surgical intervention.