Infectious Scleritis

Abstract

Scleritis is a rare but painful, indolent, locally destructive, and devastating disease of the sclera. While immune-mediated scleritis with or without systemic association forms a vast majority of the cases seen in the clinics, approximately 5–18 % of all cases of scleritis can be due to infectious process. The challenges in the diagnosis and management of infectious scleritis are multiple. The diagnosis is often delayed due to the close similarity of clinical presentation between non-infectious and infectious etiology, and also because the clinical signs of infection may be obvious only in the late stages. In addition, the use of corticosteroids in presumed non-infectious scleritis further complicates the management. Microbiological diagnosis is often elusive as the organisms lie deep within the scleral layers and repeated biopsy is sometimes required for its identification. These microbes can be indolent in nature and traditional testing to detect them may not suffice. The management of infectious scleritis is fraught with multiple hurdles. In the case of medical management, the avascular scleral tissue has poor penetration of topically applied medications—especially antifungal agents, necessitating additional parenteral therapy for prolonged periods. Surgical modalities such as debridement of infected and necrotic tissue are mandatory. In this review, we describe the clinical features, differential diagnosis, and microbiological spectrum of infectious scleritis. This review also highlights the medical and surgical management of this difficult entity and will provide a comprehensive literature review of this disease.