Chronic unilateral anterior scleritis, think about a herpetic origin: A case report

Abstract

Scleritis is a very heterogeneous group of diseases responsible for ocular inflammation of varying severity, the evolution and prognosis of which depend on the etiology but also on the appropriate treatment. We report the case of a 15-year-old female patient, without any notable general history, followed in consultation for 3 months for a nodular scleritis not improving under usual treatments. She was reconsulted when her symptoms worsened and the examination revealed a minimal reaction of the anterior chamber, in addition to the nodular scleritis localized in the temporal region, with the notion of a vesicular eruption in the perioral region on the same side of the ocular involvement and preceding the ocular symptoms by one week, consistent with a cutaneous herpes. The patient was put on oral Aciclovir (800 mg, 3 times a day) with a clear improvement marked by a decrease in pain and redness, which improved again after the introduction of oral corticoids. The existence of an extraocular sign of herpes and the good response to antiviral treatment, thus confirming the herpetic etiology of this chronic nodular scleritis. Scleritis is caused by herpes in about 5% of cases. The clinical picture is either ophthalmic herpes zoster with associated scleritis (VZV), or diffuse anterior scleritis, unilateral in 80% of cases, related to herpes simplex. The diagnosis can be confirmed by local swabs, or more often by an antiviral therapeutic test.

Bilateral Necrotizing Scleritis with Scleral Melt associated with Herpes Simplex Infection: A Case Report

“…Oral Acyclovir and corticosteroids [16] This case report presented a case of bilateral necrotizing scleritis with scleral melt, though not previously reported in the literature, the diagnosis was made based on typical associated clinical findings of keratouveitis, based on previous clinical episodes and rapid response to antiviral therapy. Because of the straightforward diagnosis, scleral biopsy was not performed.…”

“…On thorough literature search, we obtained a total of 4 cases of necrotizing scleritis, most of them being unilateral and without any scleral melt [11,12,14]. Although, the diagnosis can be confirmed on conjunctival scleral biopsy, polymerase chain reaction analysis of the aqueous sample, and positive serum anti-herpes virus titers, in most cases the decision has to be made on clinical grounds [11][12][13][14][15][16]. The literature search performed on herpetic scleritis was tabulated (Table 1).…”

“…Necrotizing scleritis is one of the ophthalmic manifestations of herpes infection that results in severe visual impairment. This association is highly uncommon and only a handful of cases have been reported [ 11 - 16 ].…”

Autoimmune scleritis: A new look at etiopathogenesis and treatment

“…Autoimmune scleritis is a rare inflammatory eye disease caused by occlusive vasculitis of the deep episcleral plexus with a risk of scleral ischemia and necrosis. [1][2][3] Complications of anterior scleritis: uveitis, peripheral ulcerative keratitis, cataracts, glaucoma, perforation of the eyeball; complications of posterior scleritis: macular edema, optic nerve, serous retinal detachment, secondary angle-closure glaucoma. These complications lead to serious vision loss.…”