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Infectious Scleritis: Pathophysiology, Diagnosis, and Management
Julia Yu1, Zeba A Syed, Christopher J Rapuano
1Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Eye & Contact Lens
|July 5, 2021
Summary
Infectious scleritis (IS), a severe eye condition, is often misdiagnosed due to similar symptoms to autoimmune scleritis. Early differentiation and prompt antibiotic treatment are crucial for better outcomes in infectious scleritis cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Infectious scleritis (IS) accounts for 5%-15% of scleritis cases and poses a diagnostic challenge due to its similarity to autoimmune scleritis.
- Delayed diagnosis of IS can lead to a poor prognosis, highlighting the critical need for accurate differentiation.
Purpose of the Study:
- To review the key diagnostic factors and clinical features suggestive of infectious scleritis.
- To discuss current management strategies and emphasize the need for established treatment guidelines.
Main Methods:
- Review of patient history and clinical examination findings associated with IS.
- Analysis of clinical features indicative of scleral infection.
- Discussion of diagnostic testing and empirical treatment approaches.
Main Results:
- Previous ocular surgery (pterygium, cataract, vitreoretinal), trauma, poor contact lens hygiene, and certain injections are common predisposing factors for IS.
- Clinical signs like scleral necrosis, hypopyon, scleral abscesses, and discharge suggest infection.
- Aggressive medical (broad-spectrum antibiotics) and surgical treatment often yield favorable outcomes.
Conclusions:
- Differentiating infectious from noninfectious scleritis is critical for timely and appropriate management.
- Prompt initiation of empiric antibiotics and a combined medical-surgical approach are generally recommended for IS.
- Further research is needed to establish consensus guidelines for managing this severe ocular condition.
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