A Case of Necrotizing Scleritis Resulting From Pseudomonas aeruginosa

Honrado, Marta Moreno; Campo, Zoraida Del; Buil, José A.

doi:10.1097/ico.0b013e3181971213

Cited by 9 publications

(8 citation statements)

References 3 publications

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“…2,5,11 Several reports have described atypical cases featuring a painfree presentation, normal visual acuity, lack of corneal infiltrates, normal intraocular pressure, and absence of anterior chamber reaction. 8,[45][46][47][48] Other uncommon manifestations include aqueous fistula formation in pneumococcal scleritis, inverse hypopyon in a case of pyomyositis with S. aureus scleritis, and spontaneous IS in immunocompromised patients with no history of ocular surgery or trauma. 5,32,49 Infectious scleritis may also masquerade as other diseases, including SINS, autoimmune scleritis, ocular tumors, orbital cellulitis, cavernous sinus thrombosis, and carotidcavernous fistula.…”

Section: Signs and Symptomsmentioning

confidence: 99%

Infectious Scleritis: Pathophysiology, Diagnosis, and Management

Syed

Rapuano

2021

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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Infectious scleritis (IS) is a rare and severe ocular disorder responsible for approximately 5%-15% of all scleritis cases. It is often associated with a poor prognosis due to its similar clinical presentation to autoimmune scleritis, resulting in a delayed diagnosis and treatment. Therefore, differentiating between infectious and noninfectious entities is critical. Several details extracted from the patient's history and clinical examination can raise suspicion for infection. The most common predisposing factor is previous ocular surgery, especially pterygium, cataract, and vitreoretinal surgeries. Ocular trauma, poor contact lens hygiene, "eye-whitening" procedures, and subtenon triamcinolone injections have also been implicated. Clinical features of infection include the presence of scleral necrosis, hypopyon, unifocal or multifocal scleral abscesses, and mucopurulent discharge. Thorough diagnostic testing is essential before excluding infection as a possibility. Empiric broad-spectrum topical and systemic antibiotic therapy should be initiated while awaiting laboratory results and adjusted accordingly. Most IS cases require both aggressive medical and surgical treatment, and various studies have reported favorable outcomes with this combination. At this time, there is no consensus on the management of this severe ocular condition, and future studies are needed to establish clear treatment guidelines.

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Section: Signs and Symptomsmentioning

confidence: 99%

Infectious Scleritis: Pathophysiology, Diagnosis, and Management

Syed

Rapuano

2021

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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“…Bacterial or fungal invasion into the sclera is uncommon, accounting for less than 1% of all eye infections 2. Scleral infection can develop during progressive microbial keratitis or panophthalmitis3,4 and has rarely occurred in the absence of contiguous disease 5…”

Section: Introductionmentioning

confidence: 99%

Management and Outcome of Microbial Anterior Scleritis

Cunningham

Alexander

Matoba

et al. 2011

Cornea

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Purpose-To evaluate the prevalence, predisposing factors, and outcomes of bacterial and fungal scleritis.Methods-We reviewed the clinical findings, therapeutic interventions, and visual outcomes of patients with suppurative scleral inflammation without preceding microbial keratitis who had microorganisms isolated from scleral scrapings. Design-Retrospective, interventional case series.Results-Of 349 patients with scleritis diagnosed from 1999 to 2009, six adults (1.7%) presented with suppurative inflammation of the anterior sclera due to Pseudomonas aeruginosa (2), Streptococcus pneumoniae (2), Staphylococcus aureus (1), or Scedosporium apiospermum (1). Each had ocular surgery of the affected eye before presentation. Intraocular extension occurred in two eyes. Following local and systemic antimicrobial therapy all improved without evisceration or enucleation, and four attained vision of 20/60 or better.Conclusions-Bacterial or fungal scleritis is an uncommon ocular infection that can belatedly follow anterior segment procedures. Antimicrobial therapy and surgical intervention can successfully control progressive suppuration and reduce vision-limiting complications.

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“…It also has an ability to form a biofilm complex, which impedes its clearance by the immune-defense mechanism [ 14 ]. Various methods of treatment in patients with infectious Pseudomonas scleritis, including topical antibiotic eye drops only [ 8 ], adjunctive oral imipenem [ 9 ], adjunctive intravenous ceftazidime and aminoglycoside [ 10 ], adjunctive surgical debridement [ 11 ], adjunctive cryotherapy [ 12 ], and autologous perichondrium graft [ 13 ] have been reported in previous studies. A study by Codère et al [ 8 ] showed failure of medical treatment with topical antibiotic eye drops only.…”

Section: Discussionmentioning

confidence: 99%

“…The most common causative pathogen of infectious scleritis is Pseudomonas aeruginosa [ 2 , 5 , 6 , 7 ], a virulent organism that can produce protease. Previous studies have reported various treatments of infectious Pseudomonas scleritis with topical antibiotic eye drops only [ 8 ], adjunctive oral imipenem [ 9 ], adjunctive intravenous ceftazidime and aminoglycoside [ 10 ], adjunctive surgical debridement [ 11 ], adjunctive cryotherapy [ 12 ], and autologous perichondrium graft [ 13 ]. This study demonstrated another option of treatment in a patient with infectious Pseudomonas scleritis.…”

Section: Introductionmentioning

confidence: 99%

Pseudomonas Scleritis following Pterygium Excision

Chaidaroon

Supalaset

2017

Case Rep Ophthalmol

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Purpose: The aim of this case report was to describe a patient who presented with Pseudomonas scleritis after pterygium excision. The study was conducted at the Department of Ophthalmology, Faculty of Medicine, Chiang Mai University in Chiang Mai, Thailand. Methods: The record of a patient who was diagnosed as Pseudomonas scleritis after pterygium excision was retrospectively reviewed for history, clinical characteristics, laboratory findings, treatments, and outcomes. Results: We described a 66-year-old male patient with a history of pterygium excision in his right eye 10 years ago, he presented with infectious scleritis. Scleral thinning, tissue necrosis, and overlying calcified plaque were found. The culture of scleral scraping revealed Pseudomonas aeruginosa. Topical fortified amikacin (20 mg/mL) and intravenous ceftazidime were started. Urgent surgical debridement of scleral infiltrates and irrigation of necrotic sclera and surrounding conjunctiva with fortified amikacin (20 mg/mL) were performed. After 2 weeks of treatment, scleral thinning and inflammation decreased, and the best-corrected visual acuity improved from 6/24 to 6/9. Fortified amikacin eye drops (20 mg/mL) were continued until the fourth week, with no scleral thinning seen. Conclusions: P. aeruginosa is a virulent organism that causes infectious scleritis complicated by melting and necrotizing of the sclera. This report emphasized that early recognition, intensive antimicrobial treatment, and surgical debridement can prevent morbidity related to this Pseudomonas infection.

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A Case of Necrotizing Scleritis Resulting From Pseudomonas aeruginosa

Abstract: This is the first case report of infectious scleritis in the context of P. aeruginosa sepsis in the absence of corneal infiltration.

Cited by 9 publications

References 3 publications

Infectious Scleritis: Pathophysiology, Diagnosis, and Management

Infectious Scleritis: Pathophysiology, Diagnosis, and Management

Management and Outcome of Microbial Anterior Scleritis

Pseudomonas Scleritis following Pterygium Excision

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