Clinical Features and Presentation of Infectious Scleritis from Herpes Viruses

Occult Fungal Scleritis

“…Subtenon injections have been reported as the cause of infectious scleritis [9,10,11], but our patient had symptoms and signs of scleral inflammation more than a month before the injection. Furthermore, the patient's first ophthalmologist could not recall using any compounded steroid on the patient.…”

“…20/50 in the affected eye). 34-80% of patients with infectious scleritis present with or develop impaired central acuity in contrast to only 3-12% with immune-mediated disease [1,11,12,13]. Sainz de la Maza et al [14] found patients with infectious scleritis have over four times the risk of presenting with or developing reduced vision versus those with other forms of scleritis [14].…”

Cytomegalovirus-related Scleritis

“…2 Among viruses the two most common causes of scleritis are varicella zoster and herpes simplex virus, the former concomitant with herpes zoster ophthalmicus. Herpetic-related scleritis usually presents as an anterior scleritis 7 and no previous case of cytomegalovirus-associated bilateral posterior scleritis has been described in an immunocompetent patient. Nevertheless, cytomegalovirus might theoretically be the pathogen responsible for a scleritis, being detected in the sclera of an HIV patient with CMV retinitis treated with ganciclovir 8 and in the sclera after intraocular inoculation in a murine model of CMV infection.…”

Treatment and management of scleral disorders

“…32, 28-67% of cases of postsurgical and post-traumatic infectious scleritis 55,58,59,132 Herpes viruses are involved in up to 8% of cases of infectious scleritis. 47,61,119 In cases of Herpes zoster ophthalmicus manifestations may not present until months later. 89 Typical clinical findings of stromal keratitis, peripheral keratitis, anterior uveitis, or Herpes zoster ophthalmicus usually lead physicians to suspect a herpetic origin; however, in cases lacking corneal findings and where clinical findings are equivocal, several signs and symptoms that should raise suspicion of herpetic scleritis include unilateral involvement, sudden-onset anterior scleritis, and moderate to intense pain.…”

“…89 Typical clinical findings of stromal keratitis, peripheral keratitis, anterior uveitis, or Herpes zoster ophthalmicus usually lead physicians to suspect a herpetic origin; however, in cases lacking corneal findings and where clinical findings are equivocal, several signs and symptoms that should raise suspicion of herpetic scleritis include unilateral involvement, sudden-onset anterior scleritis, and moderate to intense pain. 47 Following a strong clinical suspicion, scleral biopsy with immunofluorescence is recommended to establish a definitive diagnosis. 47 Patients with herpetic scleritis are more prone to vision loss than those with idiopathic scleritis.…”