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. 1998 Jan;82(1):29–34. doi: 10.1136/bjo.82.1.29

Intrascleral dissemination of infectious scleritis following pterygium excision

C Hsiao 1, J Chen 1, S Huang 1, H Ma 1, P Chen 1, R Tsai 1
PMCID: PMC1722356  PMID: 9536876

Abstract

AIMS—To assess the clinical pictures, possible pathogenesis, management, and therapy of patients with infectious scleritis associated with multifocal scleral abscesses following pterygium excision.
METHODS—The records of patients with infectious scleritis after pterygium excision who developed multifocal scleral abscesses presenting from 1988 to the end of 1995 were reviewed. Early culture of abscesses was performed, and topical, systemic antimicrobials, or both were given to all patients. Fourteen eyes were operated on in addition to antimicrobial treatment.
RESULTS—The initial culture reports of scleral ulcers identified Pseudomonas species in 12 of these 18 patients, Aspergillus in one, Mycobacterium fortuitum in one, and mixed organisms in four. Subsequent abscess cultures were taken from 15 of the infected eyes, and revealed the same organism as the initial culture in 12. Associated complications included four serous retinal detachments, three choroidal detachments, two double detachments, five complicated cataracts, and four recurrences of the initial infection. Four eyes required eventual enucleation and 11 eyes regained useful vision.
CONCLUSIONS—With subsequent abscess cultures proving to be the same organism as found in the initial ulcer, the abscess formation appears to represent intrascleral dissemination. Early diagnosis and appropriate, prolonged topical plus systemic antimicrobial treatment are essential to halt the progression of such severe infections.

 Keywords: infectious scleritis; scleral abscess; pterygium excision

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Figure 1  .

Figure 1  

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Case 1. Scleral thinning from original ulcer through subsequent abscess extended in an arc shape.

Figure 2  .

Figure 2  

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Case 5. (A) Multiple scleral abscesses (arrowheads) developed 3 weeks after excision of a nasal pterygium with mitomycin C used as adjunct. (B) A new abscess (arrowhead) at the temporal sclera, 180° from the initially involved area, was noted 1 month after discharge.

Figure 3  .

Figure 3  

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Case 13. (A) At presentation there was a calcific plaque over the scleral ulcer bed (arrowhead). The ulcer progressed and became contiguous with a corneal infiltrate (arrow). (B) Multiple new nodules (arrowheads) from which P aeruginosa was cultured, appeared on the 22nd day of hospitalisation.

Figure 4  .

Figure 4  

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Case 13. Chronic inflammatory cells infiltrated the supraciliary space (arrowhead) (haematoxylin and eosin, × 5).

Figure 5  .

Figure 5  

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Fungal elements were present in the enucleated specimen from case 3 (Gomori's methenamine silver, × 230).

Selected References

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

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