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Purpose: To report a case of Staphylococcus epidermidis infection after subtenon injection (STI) of triamcinolone acetonide (TA)., Design: Interventional case report., Methods: A 20-year-old patient with corneal graft rejection received STI of TA after insufficient response to topical and oral corticosteroids., Results: After conjunctival necrosis, necrotizing scleritis progressed although topical and systemic steroids were discontinued. Systemic ciprofloxacin, topical fortified amikacin, and vancomycine drops were used. Complete recovery was obtained after 3 weeks. Smears and cultures showed Staphylococcus epidermidis infection., Conclusions: Although 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 smear should always be taken. Prevention by sterilizing the injection site (prep and drape) and strong antibiotic prophylaxis are recommended to reduce the risk of the infectious scleritis.

Purpose: To report a case of fungal scleritis associated with exudative retinal detachment., Design: A rare case report., Methods: Nonresolving fungal scleritis mimicking noninfective scleritis was treated with systemic and topical antifungals and low topical steroids after diagnosis was established on scleral scraping. Even after complete resolution of scleritis, exudative retinal detachment persisted., Results: The patient was advised of a possible need to undergo vitreo retinal surgery if exudative retinal detachment persisted for more than a month after complete resolution of the scleritis component., Conclusion: Infective scleritis must be ruled out in cases of longstanding scleritis not responding to immunosuppressives.

Purpose: To report recurrent conjunctivitis and scleritis secondary to coexistent conjunctival pemiphigus vulgaris and cryptic herpes simplex infection., Design: Case report., Methods: Retrospective review., Results: A 54-year-old woman presented with recurrent left eye irritation and redness. Four years earlier, she was diagnosed (biopsy) with cutaneous pemphigus vulgaris requiring immunomodulatory therapies. She was receiving oral acyclovir for recurrent genital herpes and intravenous immunoglobulin for pemphigus. Examination revealed unilateral necrotizing scleritis and conjunctivitis. Immunohistochemical staining of biopsies demonstrated conjunctival pemphigus and herpes in conjunctiva and sclera. Valacyclovir therapy brought resolution., Conclusion: Cryptic ocular herpes may confound matters in someone with an autoimmune disease thought to be the sole source of ocular inflammation. Immunohistochemical analysis can resolve the mystery.

Purpose: To report an unusual case of granulomatous sclerochoroiditis., Design: Interventional case report., Methods: A patient with ANCA-associated granulomatous vasculitis presented with nodular necrotizing scleritis, which was recalcitrant to multiple systemic immunosuppressive therapies and progressed to a blind painful eye, which was enucleated., Results: Histopathology revealed extensive occlusive vasculitis, diffuse T- and B- cellular infiltration, and lymphoid granulomatous formation. Enhanced MHC class II antigens, adhesion molecules, and Fas (CD95) and FasL (CD95L) were detected in the lesion., Conclusion: Granulomatous sclerochoroiditis with aggressive immune reaction can be a complication of ANCA-associated granulomatous vasculitis.

Purpose: The authors report a case of necrotizing scleritis associated with Wegener's granulomatosis (WG), which was treated with rituximab for relapsing disease., Method: Observational case report., Results: A 32-year-old male patient presented with necrotizing scleritis in his left eye. The patient was diagnosed as having limited WG. Cyclophosphamide was begun. Under maintenance treatment with azathioprine two relapses of scleritis occurred. Since a high cumulative dose of cyclophosphamide (22.5 g) was utilized initially, two intravenous infusions of rituximab 1 g was given. Complete resolution of scleritis occurred., Conclusions: Rituximab may be effective to induce remission in patients with scleritis due to WG.

Purpose: To report a case of nodular scleritis following alendronate sodium., Methods: A 54 year-old male was treated with alendronate sodium 70 mg orally once per week. Eight weeks later, he experienced pain and redness of the right eye. Biomicroscopy was performed., Results: Patient was found to have inferonasal nodular scleritis. Laboratory work-up was unrevealing. Patient was given 4 mg of subtenon's triamcinolone acetate in the area of the nodular scleritis and had complete resolution. Two weeks following rechallenge with alendronate sodium resulted in recurrence of his scleritis., Conclusion: Alendronate led to nodular scleritis and rechallenge caused recurrence of scleritis.

Purpose: To describe a case of necrotizing scleritis due to Pseudomonas aeruginosa resistant to fourth-generation fluoroquinolones., Methods: Case report. A 50-year-old woman with no history of trauma or surgery presented with pain and redness of the left eye., Results: The patient did not respond to empiric treatment and developed scleral edema with a nummular area of avascular sclera nasally. Histopathologic examination revealed necrotizing scleritis and cultures grew P. aeruginosa resistant to fourth-generation fluoroquinolones., Conclusions: A high index of suspicion for an infectious etiology must be maintained in cases not responding to conventional noninfectious scleritis therapy and in cases with unusual presentations. Resistance to commonly used empiric antibiotics may further complicate the diagnosis and management of infectious scleritis.

Late-onset rheumatoid arthritis (LORA) is a clinically distinct entity from rheumatoid arthritis of younger onset (YORA). We present a case of necrotising anterior scleritis in an elderly lady with new-onset LORA that was initially thought to be infective. Oestrogen receptors have been identified on B cells, T cells, and macrophages with oestrogens demonstrated to increase their activation and enhance RA synovial inflammation. The presence of long-term oestrogen supplementation may have contributed to the development and perpetuation of her RA, thereby necessitating awareness of the possible immunomodulatory role of the sex steroids in immune-mediated diseases which affect the eye.

Purpose: To describe a case of anterior scleritis in a patient with stiff-person syndrome., Methods: Case report., Results: A 55-year-old woman with stable stiff-person syndrome and off immunomodulatory therapy developed unilateral anterior scleritis, which resolved over three weeks with systemic nonsteroidal anti-inflammatory therapy., Conclusions: The authors are unaware of reports regarding the association of scleritis with stiff-person syndrome.

We report a case of unilateral glaucoma with falsely low intraocular pressure reading as a result of scleral thinning from anterior scleritis.