Surgical debridement of scleral abscesses with concomitant resolution of the complicating exudative retinal detachment.

The author reports a case of severe infectious scleritis complicated by scleral abscesses and exudative retinal detachment. A 68-year-old woman with a history of pterygium excision in the left eye 13 years previously presented with pseudomonal scleritis. Despite aggressive therapy for the scleritis, the patient had complications of multifocal scleral abscesses and exudative retinal detachment. Following surgical debridement of scleral abscesses on three separate occasions and vigorous irrigation of the exposed scleral bed with antibiotics, the pathogen was eventually eradicated with subretinal fluid absorbed and the retina reattached. The patient's visual acuity reached 20/40 and she remained symptom free for 1 year after cessation of all treatments. Exudative retinal detachment, although rare, may occur in patients with severe anterior infectious scleritis. Early surgical debridement should be considered as a therapeutic option in treating deep, occult foci of scleral abscesses when antibiotic treatment alone is ineffective.