Diagnosis, Treatment, And Outcomes Of Patients With Infectious Scleritis

Abstract

Purpose: : To evaluate the inciting factors, diagnostic accuracy, causative organisms, and treatment outcomes of patients with infectious scleritis.

Results: : The authors present a series of 53 patients (55 eyes) whom were diagnosed with infectious scleritis at Bascom Palmer Eye Institute. The median age at presentation was 70 years (range 34-92). An inciting factor (including prior ocular surgery and history of trauma) could be identified in 91% of patients. The median time from identified inciting event to the occurrence of infectious scleritis was 2.4 months, with a range from 0 to 134 months. Forty-four percent of eyes were initially treated with immunosuppressive therapy (43% with local corticosteroids and 15% with systemic corticosteroids) prior to the diagnosis of infectious scleritis. A concomitant corneal or intraocular infection was identified in 18 patients. Of 55 cases of infectious scleritis, 86% were due to bacterial species while 13% were due to fungi. Medical treatment was utilized in almost all patients in the form of topical antimicrobials (95%), oral antimicrobials (78%), and intravitreal antimicrobials (11%). In addition, 44 cases required 1 or more acute surgical procedures to eradicate the infection, with 12 patients requiring enucleation. The median time to resolution of infection was 49 days (range 0 to 378 days). The time to resolution was not significantly different between eyes with a bacterial versus fungal etiology, a delay versus an immediate diagnosis of infection scleritis, or medical treatment alone versus medical treatment with adjuvant surgical intervention. Approximately 50% of patients maintained 20/200 or better visual acuity in the eye affected with scleritis over the course of their treatment and follow up.

Conclusions: : Infectious scleritis can occur days to years after ocular surgery. While intensive medical and surgical treatment can eradicate the disease in most patients, the visual prognosis is guarded due to the development of multiple concomitant ocular complications.

Keywords: sclera • microbial pathogenesis: clinical studies • bacterial disease