Patient loses vision in left eye following scleritis infection

BMJ Case Reports authors have described their treatment of a man found to have Moraxella-associated infectious scleritis.

The patient, who was in his 50s, presented to the eye emergency department with a red and painful left eye that was associated with a foreign body sensation and photophobia.

The patient had previously been diagnosed with chronic lymphocytic leukaemia in 2020 and recurrent uveitis, with the last presentation in 2017.

Visual acuity was 6/5 in the patient’s right eye and 6/24 in the left eye. An initial diagnosis of acute anterior uveitis saw the patient prescribed steroids and medication to lower intraocular pressure.

Over the next month, the patient presented to the emergency eye department six times reporting worsening symptoms.

After being referred to the outpatient uveitis clinic, the patient was diagnosed with infectious scleritis with an associated scleral melt. The scleral scrapes grew Moraxella nonliquefaciens.

The patient was prescribed oral antibiotics and discontinued using steroid drops alongside intraocular pressure lowering medication.

Six weeks after commencing antibiotic treatment, the infection had resolved. However, visual acuity was limited to counting fingers in the left eye due to cataract formation and posterior synechiae.