7.5Summary

Although immune-mediated diseases are the main disorders associated with scleritis, other, less common etiologies, such as infections must also be considered. Infectious agents, such as bacteria, fungi, viruses, and parasites, may cause scleritis through a direct invasion or through an immune response. Infectious scleritis should be suspected in cases of indolent progressive scleral necrosis with suppuration, especially if the past and present history reveals an accidental trauma, chronic topical medication use (including corticosteroids), surgical procedures, or debilitating ocular or systemic disease; they also should be suspected if the review of systems reveal multisystem Þndings compatible with a systemic infection.

In exogenous and endogenous infections, scrapings for smears and cultures must be obtained and fortiÞed antimicrobial therapy, depending on smear results, must be initiated as soon as possible. If scleral infection is the primary clinical suspicion, but smears and cultures (at 48 h) are negative, and the patient is not improving on the initial broad-spectrum antimicrobial therapy chosen, scleral or corneoscleral biopsy is recommended. Biopsied tissue may be homogenized and cultured in the usual media or analyzed by PCR, evaluated histopathologically with special stains, or analyzed by immunoßuorescence techniques.

In endogenous infections, serological tests and radiographic studies also may be helpful in suggesting the diagnosis of a speciÞc scleral infection.

Because infectious etiologies are usually treatable with antimicrobial therapy, early diagnosis improves the ocular and systemic prognoses.

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