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.' 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.