Infectious Scleritis - Clinical Characteristics, Causative Factors, and Treatment Outcomes in an Indian Population

Purpose: To study the clinical features, causative factors and treatment outcomes in patients with infectious scleritis seen in India.

Methods: A retrospective study of all patients examined at a tertiary care center between August 2012 and March 2021.

Results: Forty-five patients (45 eyes; mean age 52.7 ± 17.5 years) were included in the study. The mean duration of symptoms was 3.1 ± 4.4 months. Inciting factors were found in 53.3% (injury: 33.3%; ocular surgery: 20.0%). The scleritis was predominantly anterior (97.8%), with multiple lesions in 40.0%, a solitary lesion in 31.1%, and diffuse in 28.9%. Associated features included uveitis (51.1%), keratitis (37.8%), hypopyon (15.6%), and endophthalmitis (6.7%). Causative organisms included bacteria (53.3%), fungi (35.6%), and presumed herpes virus (11.1%). All patients were treated with antimicrobial agents along with systemic corticosteroids where indicated. Surgical treatment included scleral debridement (37.8%), patch grafts (4.4%), and penetrating keratoplasty (2.2%). Complete resolution of scleritis was seen in 86.7%, with a mean duration of therapy of 2.9 ± 2.5 months. The mean follow-up was 8.3 ± 14.3 months. 51.1% of patients lost functional vision (<6/60). Causes of decreased vision included corneal scar, cataract, macular scar, glaucomatous optic atrophy, and phthisis bulbi. On bivariate analysis, poor visual acuity at presentation was associated with a worse visual outcome (p = 0.02). Other risk factors included necrotizing scleritis, multifocal scleritis, the presence of keratitis and uveitis.

Conclusion: In our study, infectious scleritis resulted from bacterial and fungal infections. The scleritis resolved in most subjects, however, vision loss was frequent due to infection-related complications.