Infectious Scleritis Masquerading as Isolated Orbital Cellulitis: A Case Report

A woman in her fifties was presented to the emergency room with eye pain, swelling, redness, and reduced vision. The examination revealed periorbital swelling, limited extraocular motility, tenderness, and conjunctival chemosis, with thinning observed nasally at the site of prior pterygium repair. The anterior chamber was quiet, and B-scan (ultrasonography) revealed retino-choroidal thickening. Computed tomography (CT) scan results indicated septal cellulitis with clear sinuses. Laboratory workups were negative. The patient was diagnosed with orbital cellulitis and was admitted and treated accordingly. However, the patient developed recurrent attacks with hypopyon, which prompted another course of management. The patient was presented again, displaying an aggressive clinical picture, and there was a focal calcified plaque over the nasal area, suggesting necrotizing scleritis. B-scan shows T-sign and conjunctival recession, scleral scraping, debridement, and subconjunctival antibiotic injection were performed. A positive culture for Pseudomonas aeruginosa was identified. An agreement on the management of this ocular condition lacks a clear guideline. However, most infectious scleritis cases mandate a combined approach involving medical treatment and surgical debridement.