Fortunately, endophthalmitis following strabismus surgery is so rare
that some of the issues raised in Dr Bloom's letter may never be totally resolved.
It is logical to assume that scleral perforation during surgery can lead to
endophthalmitis. The more difficult question is whether endogenous endophthalmitis
exists. Recchia et al1 presented pathology
reports for 2 cases and stated that there was no evidence of scleral perforation.
Of course, a scleral perforation may have been missed. I do not know any way
to completely resolve Dr Bloom's suspicion concerning that issue.
Arthur L. Rosenbaum. Does Endophthalmitis Following Strabismus Surgery Require Scleral Perforation?. Arch Ophthalmol. 2001;119(5):784–785. doi: