Skip to main content
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1997 Nov;81(11):980–983. doi: 10.1136/bjo.81.11.980

Clinical experiences of infectious scleral ulceration: a complication of pterygium operation

C Lin 1, M Shih 1, M Tsai 1
PMCID: PMC1722042  PMID: 9505823

Abstract

AIMS—To report the special clinical manifestations and determine the appropriate management of infectious scleral ulceration.
METHODS—A retrospective study was performed on 30 eyes with infectious scleral ulceration. Information was recorded on patients' age, onset and course of disease, pathogenic organism, clinical presentations, methods of diagnosis, treatment, and outcome.
RESULTS—10 cases (33.3%) were accompanied by corneal involvement. Subconjunctival abscess was noted in 16 cases (53.3%). 17 cases (56.7%) gave positive results of pathogen culture and all were Pseudomonas aeruginosa. Two cases had combined bacterial infections and one case was complicated by fungal infection. A total of 26 cases had surgical debridement in this series. Extensive involvement of the sclera with the presence of a `tunnel lesion' or a `satellite subconjunctival abscess' were found during debridement. All of the eyeballs involved were salvaged except one.
CONCLUSION—The results of this study were contrary to the poor prognosis presented in previous reports. Early and repetitive surgical debridement is believed to be mandatory in the intractable cases to shorten the admission period and to save these eyes.



Full Text

The Full Text of this article is available as a PDF (129.1 KB).

Figure 1  .

Figure 1  

(A) The scleral ulceration was located at 9 o'clock position. Severe congestion and subconjunctival abscess were noted at 10 o'clock position under the biomicroscope. (B) After the surgical debridement, the scleral wound was left open. In comparison with (A) the involved area was more extensive. (C) Ten days later, the debrided area was healing.

Figure 2  .

Figure 2  

Figure 2  

Figure 2  

(A) During the surgical debridement, a tunnel lesion was detected with spring scissors easily entering intrastromal space. (B) Removal of the necrotic scleral tissue with spring scissors under continuous irrigation and aspiration. (C) The area involved was much larger than the visible lesion before debridement.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alfonso E., Kenyon K. R., Ormerod L. D., Stevens R., Wagoner M. D., Albert D. M. Pseudomonas corneoscleritis. Am J Ophthalmol. 1987 Jan 15;103(1):90–98. doi: 10.1016/s0002-9394(14)74175-3. [DOI] [PubMed] [Google Scholar]
  2. Brown S. I., Weller C. A., Vidrich A. M. Effect of corticosteroids on corneal collagenase of rabbits. Am J Ophthalmol. 1970 Nov;70(5):744–747. doi: 10.1016/0002-9394(70)90494-0. [DOI] [PubMed] [Google Scholar]
  3. Codère F., Brownstein S., Jackson W. B. Pseudomonas aeruginosa scleritis. Am J Ophthalmol. 1981 Jun;91(6):706–710. doi: 10.1016/0002-9394(81)90002-7. [DOI] [PubMed] [Google Scholar]
  4. Farrell P. L., Smith R. E. Bacterial corneoscleritis complicating pterygium excision. Am J Ophthalmol. 1989 May 15;107(5):515–517. doi: 10.1016/0002-9394(89)90496-0. [DOI] [PubMed] [Google Scholar]
  5. Folk J. C., Cutkomp J., Koontz F. P. Bacterial scleral abscesses after retinal buckling operations. Pathogenesis, management, and laboratory investigations. Ophthalmology. 1987 Sep;94(9):1148–1154. doi: 10.1016/s0161-6420(87)33313-5. [DOI] [PubMed] [Google Scholar]
  6. Glassroth J., Robins A. G., Snider D. E., Jr Tuberculosis in the 1980s. N Engl J Med. 1980 Jun 26;302(26):1441–1450. doi: 10.1056/NEJM198006263022603. [DOI] [PubMed] [Google Scholar]
  7. Gordon J. M., Bauer E. A., Eisen A. Z. Collagenase in human cornea: immunologic localization. Arch Ophthalmol. 1980 Feb;98(2):341–345. doi: 10.1001/archopht.1980.01020030337022. [DOI] [PubMed] [Google Scholar]
  8. HARBIN T. RECURRENCE OF A CORNEAL PSEUDOMONAS INFECTION AFTER TOPICAL STEROID THERAPY: REPORT OF A CASE. Am J Ophthalmol. 1964 Oct;58:670–674. doi: 10.1016/0002-9394(64)91386-8. [DOI] [PubMed] [Google Scholar]
  9. Hemady R., Sainz de la Maza M., Raizman M. B., Foster C. S. Six cases of scleritis associated with systemic infection. Am J Ophthalmol. 1992 Jul 15;114(1):55–62. doi: 10.1016/s0002-9394(14)77413-6. [DOI] [PubMed] [Google Scholar]
  10. Kreger A. S., Gray L. D. Purification of Pseudomonas aeruginosa proteases and microscopic characterization of pseudomonal protease-induced rabbit corneal damage. Infect Immun. 1978 Feb;19(2):630–648. doi: 10.1128/iai.19.2.630-648.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lindsey P. S., Pierce L. H., Welch R. B. Removal of scleral buckling elements. Causes and complications. Arch Ophthalmol. 1983 Apr;101(4):570–573. doi: 10.1001/archopht.1983.01040010570007. [DOI] [PubMed] [Google Scholar]
  12. MacKenzie F. D., Hirst L. W., Kynaston B., Bain C. Recurrence rate and complications after beta irradiation for pterygia. Ophthalmology. 1991 Dec;98(12):1776–1781. doi: 10.1016/s0161-6420(91)32051-7. [DOI] [PubMed] [Google Scholar]
  13. Moriarty A. P., Crawford G. J., McAllister I. L., Constable I. J. Bilateral streptococcal corneoscleritis complicating beta irradiation induced scleral necrosis. Br J Ophthalmol. 1993 Apr;77(4):251–252. doi: 10.1136/bjo.77.4.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Moriarty A. P., Crawford G. J., McAllister I. L., Constable I. J. Severe corneoscleral infection. A complication of beta irradiation scleral necrosis following pterygium excision. Arch Ophthalmol. 1993 Jul;111(7):947–951. doi: 10.1001/archopht.1993.01090070065021. [DOI] [PubMed] [Google Scholar]
  15. O'Donoghue E., Lightman S., Tuft S., Watson P. Surgically induced necrotising sclerokeratitis (SINS)--precipitating factors and response to treatment. Br J Ophthalmol. 1992 Jan;76(1):17–21. doi: 10.1136/bjo.76.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ormerod L. D., Puklin J. E., McHenry J. G., McDermott M. L. Scleral flap necrosis and infectious endophthalmitis after cataract surgery with a scleral tunnel incision. Ophthalmology. 1993 Feb;100(2):159–163. doi: 10.1016/s0161-6420(93)31676-3. [DOI] [PubMed] [Google Scholar]
  17. Pope J., Jr, Sternberg P., Jr, McLane N. J., Potts D. W., Stulting R. D. Mycobacterium chelonae scleral abscess after removal of a scleral buckle. Am J Ophthalmol. 1989 May 15;107(5):557–558. doi: 10.1016/0002-9394(89)90511-4. [DOI] [PubMed] [Google Scholar]
  18. Raber I. M., Laibson P. R., Kurz G. H., Bernardino V. B. Pseudomonas corneoscleral ulcers. Am J Ophthalmol. 1981 Sep;92(3):353–362. doi: 10.1016/0002-9394(81)90524-9. [DOI] [PubMed] [Google Scholar]
  19. Reynolds M. G., Alfonso E. Treatment of infectious scleritis and keratoscleritis. Am J Ophthalmol. 1991 Nov 15;112(5):543–547. doi: 10.1016/s0002-9394(14)76856-4. [DOI] [PubMed] [Google Scholar]
  20. Rubinfeld R. S., Pfister R. R., Stein R. M., Foster C. S., Martin N. F., Stoleru S., Talley A. R., Speaker M. G. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology. 1992 Nov;99(11):1647–1654. doi: 10.1016/s0161-6420(92)31749-x. [DOI] [PubMed] [Google Scholar]
  21. Schönherr U., Naumann G. O., Lang G. K., Bialasiewicz A. A. Sclerokeratitis caused by Mycobacterium marinum. Am J Ophthalmol. 1989 Nov 15;108(5):607–608. doi: 10.1016/0002-9394(89)90449-2. [DOI] [PubMed] [Google Scholar]
  22. Sevel D. Necrogranulomatous scleritis. Effects on the sclera of vascular deprivation. Br J Ophthalmol. 1968 Jun;52(6):453–460. doi: 10.1136/bjo.52.6.453. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Singh G. Postoperative instillation of low-dose mitomycin C in the treatment of primary pterygium. Am J Ophthalmol. 1989 May 15;107(5):570–571. doi: 10.1016/0002-9394(89)90523-0. [DOI] [PubMed] [Google Scholar]
  24. Stonecipher K. G., Parmley V. C., Jensen H., Rowsey J. J. Infectious endophthalmitis following sutureless cataract surgery. Arch Ophthalmol. 1991 Nov;109(11):1562–1563. doi: 10.1001/archopht.1991.01080110098044. [DOI] [PubMed] [Google Scholar]
  25. Tamesis R. R., Foster C. S. Ocular syphilis. Ophthalmology. 1990 Oct;97(10):1281–1287. doi: 10.1016/s0161-6420(90)32419-3. [DOI] [PubMed] [Google Scholar]
  26. Tarr K. H., Constable I. J. Late complications of pterygium treatment. Br J Ophthalmol. 1980 Jul;64(7):496–505. doi: 10.1136/bjo.64.7.496. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Tarr K. H., Constable I. J. Pseudomonas endophthalmitis associated with scleral necrosis. Br J Ophthalmol. 1980 Sep;64(9):676–679. doi: 10.1136/bjo.64.9.676. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wilhelmus K. R., Yokoyama C. M. Syphilitic episcleritis and scleritis. Am J Ophthalmol. 1987 Dec 15;104(6):595–597. doi: 10.1016/0002-9394(87)90170-x. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES