Localized transscleral staphylococcal abscess simulating a neoplasm

A 47-year-old woman with a history of breast cancer developed a focal epibulbar mass in the right eye. The initial diagnosis was nodular episcleritis, but the lesion failed to respond to local and systemic corticosteroids. The rule out an epibulbar metastatic carcinoma an excisional biopsy was performed, which demonstrate a localized staphylococcal abscess that had locally eroded the sclera and exposed the underlying uveal tract. Covering the defect with a scleral patch graft and promptly instituting oral amoxicillin/clavulanic acid and topical cefazolin treatment resulted in an uncomplicated recovery. Infectious scleral abscess in an uncommon entity and the differential diagnosis includes nodular episcleritis and epibulbar metastatic tumor.