Scleritis: Differentiating infectious from non-infectious entities

Murthy, Somasheila I; Sabhapandit, Swapnali; Balamurugan, S.; Subramaniam, Pranesh; Maza, Maite Sainz de la; Agarwal, Manisha; Parvesio, Carlos

doi:10.4103/ijo.ijo_2032_20

Cited by 47 publications

(45 citation statements)

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“…The clinical picture is similar to immune mediated scleritis. Around 30 to 50% of the non-infectious type of scleritis is associated with underlying autoimmune disease [ 5 ]. Autoimmune scleritis is characterized by varying mixtures of palisading granulomas, necrosis, and vasculitis.…”

Section: Discussionmentioning

confidence: 99%

A case of anterior scleritis in association with posterior scleritis – a diagnostic riddle

Dastidar

Goel

Kundu

et al. 2022

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We herein report a case of a young female presenting with multiple nodular scleral abscesses mimicking infective scleritis with exudative retinal detachment. Repeated diagnostic scraping for microbiological and histopathological analysis was inconclusive. The patient’s systemic and collagen disease work-up was non-contributory. She was treated with multiple surgical debridement and de-roofing of the abscesses along with antibiotic irrigation. Topical and oral steroid was stopped on worsening of the condition, and the patient was maintained on topical and oral antibiotics. Complete resolution of scleritis and exudative detachment was noted at 1 month follow-up and no recurrence was noted until 6 months.

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Section: Discussionmentioning

confidence: 99%

A case of anterior scleritis in association with posterior scleritis – a diagnostic riddle

Dastidar

Goel

Kundu

et al. 2022

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“…Aggressive surgical management may often be required for globe salvage in these cases. Pseudomonas, Staphylococcus, and Herpes zoster are common agents that can cause infectious scleritis which mimics autoimmune disease [8,14].…”

Section: Discussionmentioning

confidence: 99%

“…Scleritis is more commonly associated with autoimmune disorders and infectious scleritis accounts for only 5 -10 % of all the scleritis cases [3][4][5][6]. The initial presentation of infectious scleritis can mimic its immune mediated counterpart [7,8]. Topical and systemic steroids, whilst bene cial in immune mediated scleritis, worsen infectious scleritis.…”

Section: Introductionmentioning

confidence: 99%

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A Novel Technique of Full-Thickness Scleral Debridement in Fulminant Necrotising Infectious Scleritis and Its Outcomes - A Consecutive Case Series

Karkhur

Soni

Sharma

2021

Preprint

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PurposeWe report the outcomes of a novel technique of scleral debridement in five consecutive cases of relentlessly progressive and fulminant infectious scleritis following corticosteroid exposure.MethodsFive consecutive patients of infectious scleritis with a common history of corticosteroids exposure; resulting from either an initial misdiagnosis of autoimmune scleritis or as an adjunct to specific antimicrobial therapy. Data collection included presentation details including photographs, clinical findings, microbiological analysis, treatment details and audit of surgical videos. Cases with undisputed diagnosis of infectious scleritis with microbiological evidence; without corticosteroid use, were excluded from study.ResultsAfter full-thickness scleral debridement and cessation of corticosteroids, favourable anatomical and visual outcome was observed in all cases; however, two patients required multiple scleral debridements due to progressive scleritis. Scleral patch graft was not used in any case. Microbiology detected infective organisms in two cases, while the remaining revealed negative results. Therefore, specific antimicrobial therapy was initiated in former, whereas empirical broad-spectrum regimen in patients with repeatedly negative results. No recurrence of scleritis or development of ciliary staphyloma was noted and anatomical integrity was maintained at normal intraocular pressure during follow-up.ConclusionThis study highlights the fulminant and relentlessly progressive clinical course, that infectious scleritis can metamorphose into, despite specific anti-microbial therapy, if inadvertent corticosteroid therapy is administered. Full-thickness debridement without scleral patch graft could achieve elimination of infectious foci with favourable long-term anatomical and visual outcome. This technique could offer a potential last resort approach in such cases where standard therapeutic modalities have not been successful.

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“…The issue begins with a beautiful account of the history and evolution of the USI, pays tribute to the pioneers of uveitis practice in India, and then moves on to many different forms of uveitis and scleritis. [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ]…”

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confidence: 99%