Treatment of infectious scleritis and keratoscleritis

We reviewed 28 cases of culture-proven infectious scleritis and keratoscleritis to clarify the role of an operation in this disorder. Surgical management in 11 patients with keratoscleritis included cryotherapy, five; penetrating corneal-scleral graft, two; lamellar corneoscleral graft, two; and tectonic penetrating keratoplasty, two; in addition to intensive fortified antibiotic eyedrops. Eight patients with keratoscleritis were treated medically only with intensive fortified frequent antibiotic eyedrops, one; intensive instilled plus intravenous antibiotics, three; and instilled, intravenous, and subconjunctival antibiotics, four. Seven of eight patients treated with antibiotics alone and two of 11 patients who received surgical intervention in addition to antibiotics eventually required evisceration or enucleation of the eye. These results suggest that cryotherapy, lamellar or penetrating corneoscleral graft, in addition to intensive antibiotic therapy, may improve the outcome of patients with infectious keratoscleritis. Five eyes with isolated scleritis without corneal involvement were treated with conjunctival recession and cryotherapy in addition to aggressive antibiotics, and four were treated with antibiotics alone. The infections of these nine patients resolved.