Aims-To assess the clinical pictures, possible pathogenesis, management, and therapy of patients with infectious scleritis associated with multifocal scleral abscesses following pterygium excision. Methods-The records of patients with infectious scleritis after pterygium excision who developed multifocal scleral abscesses presenting from 1988 to the end of 1995 were reviewed. Early culture of abscesses was performed, and topical, systemic antimicrobials, or both were given to all patients. Fourteen eyes were operated on in addition to antimicrobial treatment. Results-The initial culture reports of scleral ulcers identified Pseudomonas species in 12 of these 18 patients, Aspergillus in one, Mycobacterium fortuitum in one, and mixed organisms in four. Subsequent abscess cultures were taken from 15 of the infected eyes, and revealed the same organism as the initial culture in 12. Associated complications included four serous retinal detachments, three choroidal detachments, two double detachments, five complicated cataracts, and four recurrences of the initial infection. Four eyes required eventual enucleation and 11 eyes regained useful vision. Conclusions-With subsequent abscess cultures proving to be the same organism as found in the initial ulcer, the abscess formation appears to represent intrascleral dissemination. Early diagnosis and appropriate, prolonged topical plus systemic antimicrobial treatment are essential to halt the progression of such severe infections. (Br J Ophthalmol 1998;82:29-34) Pterygium excision is thought to be a simple and safe surgical procedure, but may be complicated by infectious scleritis that can be destructive and visually disabling.1-7 When we treated the patients with infectious scleritis following pterygium excision, we found that some had multiple scleral nodules which had the potential to increase in size and number, and even perforate with purulent discharge. Previous reports regarding infectious scleritis following pterygium excision emphasised management and prognosis, but multifocal scleral nodules have received little attention.6 Whether these nodules are the result of an infectious process or an immune response, they may complicate the management of infectious scleritis. To try to ascertain the relation of multiple scleral abscesses to infectious scleritis, we focused on these cases of infectious scleritis in association with multiple scleral abscesses following pterygium excision and took cultures from the scleral nodules to study the possible pathogenesis. We also discuss the clinical features and management of this potentially devastating condition. Patients and methodsWe reviewed the medical records of patients who developed multiple scleral nodules associated with infectious scleritis following pterygium excision and were treated at our hospital from 1988 to the end of 1995. That is, the patients presented with culture proved infectious scleritis at the bare sclera of pterygium excision and then multiple sclera nodules appeared. Twenty three patients me...

The two-stage surgery is a safe and effective modality.