![]() Ocular surgery such as pterygium surgery (57%), scleral buckle (8%), cataract removal (10%), strabismus, glaucoma filtration surgery, suture removal, and vitreoretinal procedures have all been implicated for infectious scleritis. Predisposing factors to a primary infection include systemic infection, systemic/topical steroid use (39%), and previous diagnosis of autoimmune scleritis. Infectious scleritis can follow trauma (10%), infectious endophthalmitis, or adjacent keratitis. Primary scleritis occurs following an accidental or surgical injury (58.5 to 88%). The etiology of infectious scleritis can be primary or secondary. Untreated, infectious scleritis can result in the loss of the eye due to the spread of infection to surrounding structures or perforation of the globe. Other known vectors include bacteria or fungal organisms such as Nocardia, Streptococcus, Haemophilus, Candida, and Aspergillus. Several organisms have been identified as agents for infectious scleritis, with Pseudomonas aeruginosa reported as the most common organism in developed countries. Other correlated factors included prior accidental eye injury, use of radiation, and the use of an antineoplastic like mitomycin. The most common factor was previous ocular surgery (83%), particularly pterygium excision (57%), which was the majority of cases. About 94% of patients (n=48) had a predisposing factor for the infection. To differentiate infectious from autoimmune scleritis, accurate history is crucial. The clinical symptoms for both infectious and autoimmune scleritis can appear similar. As a result, infectious cases may be managed as autoimmune, possibly worsening the outcome. Although the majority of scleritis cases are due to an autoimmune etiology, approximately 5 to 10% of cases are infectious. Symptoms of scleritis can involve focal or diffuse hyperemia, pain, and visual impairment. Scleritis can concurrently involve the cornea, episclera, and uvea. Scleritis is an inflammation of the sclera, the outer layer of the globe.
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