Pseudomonas Scleritis following Pterygium Excision

Abstract

Purpose: The aim of this case report was to describe a patient who presented with Pseudomonas scleritis after pterygium excision. The study was conducted at the Department of Ophthalmology, Faculty of Medicine, Chiang Mai University in Chiang Mai, Thailand. Methods: The record of a patient who was diagnosed as Pseudomonas scleritis after pterygium excision was retrospectively reviewed for history, clinical characteristics, laboratory findings, treatments, and outcomes. Results: We described a 66-year-old male patient with a history of pterygium excision in his right eye 10 years ago, he presented with infectious scleritis. Scleral thinning, tissue necrosis, and overlying calcified plaque were found. The culture of scleral scraping revealed Pseudomonas aeruginosa. Topical fortified amikacin (20 mg/mL) and intravenous ceftazidime were started. Urgent surgical debridement of scleral infiltrates and irrigation of necrotic sclera and surrounding conjunctiva with fortified amikacin (20 mg/mL) were performed. After 2 weeks of treatment, scleral thinning and inflammation decreased, and the best-corrected visual acuity improved from 6/24 to 6/9. Fortified amikacin eye drops (20 mg/mL) were continued until the fourth week, with no scleral thinning seen. Conclusions: P. aeruginosa is a virulent organism that causes infectious scleritis complicated by melting and necrotizing of the sclera. This report emphasized that early recognition, intensive antimicrobial treatment, and surgical debridement can prevent morbidity related to this Pseudomonas infection.