Posters

Infectious and necrotizing scleritis after subtenon triamcinolone acetonide injection

Poster Details

First Author: M.Abrishami IRAN

Co Author(s):    H. Gharaee                    

Abstract Details

Purpose:

To report a case of Staphylococcus epidermidis infection after subtenon injection (STI) of triamcinolone acetonide (TA).

Setting:

Khatam-al-Anbia Hospital, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Methods:

A 20-year old man with a history of penetrating keratoplasty ten months before was referred fortreatment of corneal graft rejection. He had severe reduction in his vision (five lines), ocular pain, severe stromal corneal edema, conjunctival injection (1+), and keratic precipitates. He had been treated by topical betamethasone eye drop every 2 hours and oral prednisolone 50 mg every day. Because of insufficient response after a week, STI of 0.5 ml TA was performed. The patient was ordered to use betamethasone and prednisolone as before in addition to topical Chloramphenicol eye drop every 8 hours.

Results:

Two days after STI, the patient presented with increasing ocular pain and ocular discharge. On ocular examination, mild corneal edema, anterior chamber reaction, localized conjunctival necrosis at injection site were observed. Topical betamethasone was discontinued and replaced with an ocular lubricant. Four days after injection, conjunctival necrosis progressed to scleral necrosis, a stage at which oral prednisolon was discontinued, and tissue smear and cultures even for bacteria, fungi, and anaerobes were taken. Oral and fortified drops were initiated frequently. Total cure with scleral vascularization occurred after three weeks . The cultures and smears were shown Staphylococcus epidermidis infection.

Conclusions:

Despite being uncommon, infectious scleritis can occur following uncomplicated subconjunctival corticosteroid injections. Infectious scleritis can be very difficult to diagnose as it may mimic an immune mediated disease. If the conjunctiva is suspected to be involved, a swab should always be taken. Injection under sterile condition, fair patient selection, being suspicious about the infectious complications and managing the patient with frequent fortified topical and systemic antibiotics is preferred.

Financial Disclosure:

None