Infectious scleritis: Clinical profile and treatment outcome in a tertiary eye care center in Southern India

Purpose: The purpose of the study is to study the clinical features, causative organisms, and treatment outcome in cases of infectious scleritis. Design: This is a retrospective study. Materials and Methods: Medical and microbiological records of all patients diagnosed as infectious scleritis between January 2016 and December 2019 were reviewed. Information including age, sex, clinical features, predisposing factor, causative organism, and treatment outcome was extracted from records and analyzed. Results: A total of 12 cases of infectious scleritis were identified. Five (41.6%) cases had a prior history of trauma and 3 (25%) cases had undergone cataract surgery in the past. Redness with pain in the involved eye was the most common presenting complaint (91.6%, n = 11). Most of the cases (n = 11, 91.6%) presented with visible scleral abscess under slit-lamp examination. Fifty percent cases (n = 6) were caused due to fungal infection, most common species being Aspergillus (41.6%, n = 5). Pseudomonas aeruginosa (25%, n = 3) was the second most common causative organism. Microbe-specific medical treatment was given and scleral debridement done for all the eyes. Globe was preserved in 83.3% (n = 10) of the eyes. About 41.6% (n = 5) of eyes had best-corrected visual acuity 6/18 or better at the end of 3 months. Conclusion: Previous history of trauma should raise high suspicion regarding infectious etiology in any case of scleritis. In cases with no antecedent history, subtle clinical differences between autoimmune and infective scleritis, along with response to therapy, should be kept in mind to reach at a diagnosis. In tropical countries like India, fungi, most commonly Aspergillus flavus, are the most common organism responsible for infective scleritis. Along with medical treatment, surgical debridement plays a major role in the management of infective scleritis.