Infectious scleritis

Infectious scleritis is a rare and serious inflammatory condition of the sclera (the tough, white outer coat of the eye) caused by microbial organisms, including bacteria, fungi, viruses, or parasites. Unlike autoimmune or idiopathic scleritis, infectious scleritis results from direct invasion of the scleral tissue by pathogens. It most commonly occurs following ocular surgery (particularly pterygium surgery with adjunctive mitomycin C or beta-irradiation), ocular trauma, or extension of infection from adjacent structures such as the cornea. Rarely, it may arise from hematogenous spread of systemic infections. The condition primarily affects the eye but can lead to devastating complications including scleral necrosis, perforation, endophthalmitis, and permanent vision loss if not promptly diagnosed and treated. Key symptoms include severe, deep ocular pain that may worsen at night and with eye movement, localized or diffuse redness of the eye, tenderness, tearing, photophobia, and decreased visual acuity. A characteristic finding may include a scleral abscess or area of scleral necrosis with surrounding inflammation. The most commonly implicated organisms include Pseudomonas aeruginosa, Staphylococcus species, Streptococcus species, Nocardia, and various fungi such as Aspergillus and Fusarium species. Atypical mycobacteria and Acanthamoeba are also recognized causative agents. Diagnosis requires a high index of clinical suspicion, particularly in patients with a history of prior ocular surgery or trauma. Scleral biopsy or scraping with microbiological cultures and sensitivity testing is essential for identifying the causative organism and guiding targeted therapy. Treatment involves intensive, prolonged antimicrobial therapy tailored to the identified pathogen, which may include topical, subconjunctival, systemic, or intravitreal antibiotics or antifungals. Surgical debridement of necrotic scleral tissue may be necessary, and scleral patch grafting may be required in cases of significant tissue loss or perforation. Despite aggressive treatment, the prognosis can be guarded, and some patients may experience significant visual morbidity.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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