Management and Outcome of Microbial Anterior Scleritis

In this retrospective case series, we studied the predisposing factors, causative organisms, clinical spectrum, and outcomes of 12 cases of culture-proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental). Past surgical history included small-incision cataract surgery (4), pterygium surgery (1), and trabeculectomy (1). Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18). A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005). Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209), but resulted in a higher globe preservation rate (P = 0.045). Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.

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“…[713] This suggests that early diagnosis should help preserve the patient's remaining vision if effective treatment is initiated.…”

Section: Discussionmentioning

confidence: 99%

Infectious scleritis: Clinical spectrum and management outcomes in India

Pradhan

Jacob

2013

Indian J Ophthalmol

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“…The predictors of poor outcome include poor presenting visual acuity (less than 20/200), scleral thinning, lengthy hospitalization, associated keratitis, and endophthalmitis [22,58]. The number of patients with poor visual and anatomical outcome can range form 6 to 33 % [9 •• , 11 •• ].…”

Section: Discussionmentioning

confidence: 99%

“…Other fungi that are less commonly associated with scleritis include Metarhizium anisopliae [56], Paecilomyces lilacinus [22,59,60,69], Scedosporium apiospermum [47,61,62], Cephalosporium species [36], Penicillium species [36], Cladosporium [2,14], Candida parapsilosis [22,39], Pseudallescheria boydii [63], Fusarium species [3,8,22,48], Rhizopus species [64], Acremonium species [4,14,22], Curvularia lunata [58], and Colletotrichum dematium [65]. Previously considered a protozoan, microsporidia has been recently classified as fungi and although it is a common cause of keratoconjunctivitis, it is a rare cause of scleritis.…”

Section: Microbiological Profilementioning

confidence: 99%

Infectious Scleritis

Murthy

Reddy

Sharma

et al. 2015

Curr Ophthalmol Rep

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Scleritis is a rare but painful, indolent, locally destructive, and devastating disease of the sclera. While immune-mediated scleritis with or without systemic association forms a vast majority of the cases seen in the clinics, approximately 5-18 % of all cases of scleritis can be due to infectious process. The challenges in the diagnosis and management of infectious scleritis are multiple. The diagnosis is often delayed due to the close similarity of clinical presentation between non-infectious and infectious etiology, and also because the clinical signs of infection may be obvious only in the late stages. In addition, the use of corticosteroids in presumed non-infectious scleritis further complicates the management. Microbiological diagnosis is often elusive as the organisms lie deep within the scleral layers and repeated biopsy is sometimes required for its identification. These microbes can be indolent in nature and traditional testing to detect them may not suffice. The management of infectious scleritis is fraught with multiple hurdles. In the case of medical management, the avascular scleral tissue has poor penetration of topically applied medications-especially antifungal agents, necessitating additional parenteral therapy for prolonged periods. Surgical modalities such as debridement of infected and necrotic tissue are mandatory. In this review, we describe the clinical features, differential diagnosis, and microbiological spectrum of infectious scleritis. This review also highlights the medical and surgical management of this difficult entity and will provide a comprehensive literature review of this disease.

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“…Microbial scleritis is an infrequent ocular infection. According to Cunningham et al 4 the prevalence of primary bacterial or fungal scleritis among patients with scleritis is estimated to be 1.7%.…”

Section: Discussionmentioning

confidence: 99%

A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolones

Reis

Albuquerque

Hummel

et al. 2016

Revista Brasileira De Oftalmologia

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RESUMONós descrevemos um raro caso de esclerite por Nocardia spp em uma criança sadia resistente a utilização tópica de fluorquinolona de quarta-geração. Clinicamente, a paciente apresentou apenas uma resposta parcial do quadro de esclerite a terapêutica inicial. O tratamento foi então modificado para meropenem intravenoso e amicacina tópica. Após várias semanas de tratamento com antibiótico, o quadro infeccioso regrediu porém a visao da pacientes evoluiu para perda da percepção luminosa. Em casos de esclerite necrotizante em pacientes sem fatores de risco aparente é necessário considerer a Nocardia Asteroides como possível agente causador. Os testes de sensibilidade medicamentosa apresentam importância significativa em virtude do aparecimento de resistência aos novos medicamentos. ABSTRACTWe describe an unusual case of Nocardia spp scleritis in a health girl resistant to topical fourth-generation fluoroquinolones. Clinically, there was only partial response of the scleritis to initial therapy. Treatment was changed to meropenem intravenously and topical amikacin. Following several weeks of antibiotic treatment, the patient's infection resolved but her vision was reduced to no light perception. Nocardia asteroides must be considered as a possible agent in cases of necrotizing scleritis in patients without a clear source. Antibiotic sensitivity testing has a definitive role in view of the resistance to these new medications.

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Management and Outcome of Microbial Anterior Scleritis

Cited by 26 publications

References 27 publications

Infectious scleritis: Clinical spectrum and management outcomes in India

Infectious scleritis: Clinical spectrum and management outcomes in India

Infectious Scleritis

A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolones

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