Early-Onset Scleral Dellen after Pterygium Excision: A Case Series

Background: Scleral dellen is a rare, non-infectious complication of pterygium surgery caused by localized scleral dehydration and tear film instability. Although uncommon, delayed diagnosis may lead to severe scleral thinning and uveal exposure. Objective: To describe the clinical presentation, management, and outcomes of scleral dellen following pterygium excision and to highlight preventive strategies. Case Presentation: We report four male patients aged 38–65 years who developed scleral dellen between 5 and 16 days after primary pterygium excision with conjunctival autograft, performed without mitomycin C. All patients presented with localized scleral thinning without signs of infection or systemic inflammatory disease. Results: Three patients responded favorably to intensive conservative treatment including preservative-free lubricants, topical antibiotics, autologous serum eye drops (30%), and ocular patching. One patient with deep scleral thinning and uveal show required amniotic membrane transplantation. Complete healing was achieved in all cases within four weeks, with no residual scleral defects. Conclusion: Scleral dellen is an uncommon but potentially serious early postoperative complication of pterygium surgery. Early recognition, aggressive ocular surface lubrication, cautious steroid use, and timely surgical intervention when indicated lead to excellent outcomes. Preventive measures remain essential to minimize risk.