BACKGROUND: Infective scleritis is very rare as compared to immune-mediated scleritis and high degree of suspicion is needed to diagnose the cases. To diagnose it, scleral biopsy along with culture is mandatory. A 62-year-old male patient presented with chief complaints of pain, redness, photophobia, lacrimation followed by injury with a vegetative matter since last one and a half months. On examination, scleral abscess was noted at superior paralimbal region, which was treated by deroofing, debridement and taking biopsy. Fungal filaments were seen. Treatment with topical amphotericin B 0.015% along with oral fluconazole 200 mg daily. Signs and symptoms improved gradually over a period of 6 months. Further scleral nodules and abscess appeared in a clockwise pattern, which were treated as before. Prolonged treatment with topical amphotericin B and oral fluconazole after deroofing and debridement and biopsy helps in management of fungal scleritis. After proper diagnosis and culture sensitivity management of fungal scleritis needs prolonged treatment with both topical and systemic antifungals after deroofing as ocular penetration of topical antifungals is very poor.

Thyroid-associated orbitopathy (TAO) is the most frequent extrathyroidal manifestation of Graves’ disease. It is an autoimmune process affecting the retrobulbar tissue. It is the most common cause of bilateral and unilateral exophthalmos among adults. The clinical presentation may vary from mild disease to severe irreversible sight-threatening complications. Till date, TAO remains a major diagnostic and therapeutic challenge. Diagnosis of orbitopathy is mainly clinical and treatment is based on the clinical severity of the disease. In this article, we review the pathophysiology, epidemiology, classification, clinical presentation, and management of this common yet challenging orbital inflammatory disease.