Abstract
Background Inflammatory scleral disease is frequently associated with autoimmune disorders and only occasionally caused directly by an infective agent. Fungal infections primarily involving the sclera are rare, and the outcome is generally poor. Here we report three patients with post-operative Aspergillus scleritis who were successfully managed by medical therapy and surgical intervention.
Patients Scleral infection with Aspergillus sp. was diagnosed 6 and 5 months after cataract extraction in a 76-year-old diabetic and an 82-year-old woman respectively, and in a 54-year-old man 3 months after trabeculectomy. Swabs and/or scrapings had not been conclusive and the diagnosis of Aspergillus infection was established in all cases only after scleral biopsy.
Results The infection was eliminated in all cases. This was achieved in one eye by treatment with oral itraconazole in combination with systemic and topical amphotericin B. The two patients with fungal scleritis after cataract extraction required in addition to the medical therapy (oral itraconazole, topical econazole and amphotericin B) scleral excisions and patch grafts to control infection.
Conclusion Fungal scleritis may remain undiagnosed for months. A scleral biopsy may be necessary to establish this diagnosis. Prolonged systemic antifungal therapy alone may not eradicate fungal infection. Surgical excision improves the outcome of fungal scleritis.
Similar content being viewed by others
Article PDF
References
Watson PG . Diseases of the sclera and episclera. In: Duane TD, Jaeger EA. Clinical ophthalmology, vol 4. Philadelphia: JB Lippincott, 1995:1–45.
Köllner H . Schimmelpilzerkrankung der Sklera. Z Augenheilkd 1906;16:441–7.
Lincoff HA, McLean JM, Nano H . Scleral abscess. I. A complication of retinal detachment buckling procedures. Arch Ophthalmol 1965;74:641–8.
Milauskas AT, Duke JR . Mycotic scleral abscess: report of a case following a scleral buckling operation for retinal detachment. Am J Ophthalmol 1967;63:951–1.
Margo CK, Polack FM, Mood CI . Aspergillus panophthalmitis complicating treatment of pterygium. Cornea 1988;7:285–9.
Moriarty AP, Crawford GJ, McAllister IL, Constable IJ . Fungal corneoscleritis complicating beta-irradiation-induced scleral necrosis following pterygium excision. Eye 1993;7:525–8.
Podedworny W, Suie T . Mycotic infection of the sclera. Am J Ophthalmol 1964;57:494.
Carlson AN, Foulks GN, Perfect JR, Kim JH . Fungal scleritis after cataract surgery. Cornea 1991;11:151–4.
Chaillous J . Sporotrichose gommeuse disseminée, gomme intraoculaire, perforation de la sclerotique. Ann Ocul (Paris) 1912;148:321–8.
Stenson S, Brookner A, Rosenthal S . Bilateral endogenous necrotising scleritis due to Aspergillus oryzae. Ann Ophthalmol 1982;14:67–72.
Griffiths M, Clayton YM, Dart JKG . Antifungal sensitivity testing of keratitis isolates at Moorfields Eye Hospital 1975–1990: therapeutic implications. In: Bialasiewicz AA, editor. Infectious diseases of the eye: an update. Buren: Aeolus Press, 1994:190–4.
O'Doneghue E, Lightman S, Tuft S, Watson P . Surgically induced necrotising sclerokeratitis (SINS): precipitating factors and response to treatment. Br J Ophthalmol 1992;76:17–21.
Sainz de la Maza M, Foster CS . Necrotising scleritis after ocular surgery: a clinicopathologic study. Ophthalmology 1991;98:1720–62.
Polack FM, Kaufman HE, Newmark E . Keratomycosis: medical and surgical treatment. Arch Ophthalmol 1971;85:410–6.
Allan BDS, Dart JKG . Strategies for the management of microbial keratitis. Br J Ophthalmol 1995;79:777–86.
O'Day DM . Selection of appropriate antifungal therapy. Cornea 1987;6:238–45.
Mori T, Matsumara M, Ebe T, Takahashi M, Kohara T, Inagaki M, et al. Clinical study of treatment of fungal infection with itraconazole. Jpn J Med Mycol 1991;32:279–90.
Koenig SB . Fungal keratitis. In: Tabbarra KF, Hyndiuk RA. Infection of the eye. Boston: Little, Brown, 1986:331–42.
Jones DB . Pathogenesis of bacterial and fungal keratitis. Trans Ophthalmol Soc UK 1978;98:367–71.
Reynolds MG, Alfonso E . Treatment of infectious scleritis and keratoscleritis. Am J Ophthalmol 1991;112:543–7.
Alfonso E . Surgical intervention in infectious keratoscleritis [letter]. Arch Ophthalmol 1994;112:1017–8.
Author information
Authors and Affiliations
Additional information
W.B. was supported in part by the Swiss National Science Foundation and by a locally organised research scheme from Moorfields Eye Hospital
Proprietary interest: None
Rights and permissions
About this article
Cite this article
Bernauer, W., Allan, B. & Dart, J. Successful management of Aspergillus scleritis by medical and surgical treatment. Eye 12, 311–316 (1998). https://doi.org/10.1038/eye.1998.71
Issue Date:
DOI: https://doi.org/10.1038/eye.1998.71