Superficial epithelioid schwannoma presenting as a subcutaneous upper eyelid mass.

scleritis have been reported following pterygium surgery,3 scleral buckling procedures4 and cataract surgery.5 Trauma has been described as a cause for mycotic scleritis,67 but our patient did not recall any eye injury. Although these reported cases refer to exogenous infections, with agents other than A niger, they do show similarities to our case. Clinically, severe headaches and periocular pain are common findings, with symptoms that wax and wane following use of corticosteroids. In all cases, a delay in diagnosis was encountered. We cannot exclude the possibility that an infection was introduced at the time of the subconjunctival injections of corticosteroids, but the scleritis was present before the first injection and the original presentation did not differ significantly from subsequent recurrences. Furthermore, the location of the injection was away from the location of the scleritis. As mentioned above, apart from trauma and surgery, a third source of infection can be endogenous spread from another infected site for example, following injecting drug use.' 2 In spite of an extensive examination, no source of infection could be identified in our patient. However, since our patient had a history of drug misuse, such an endogenous route related to drug misuse cannot be excluded. Since she had also been treated for automutilation of the breast, automutilation of the eye as a source of Aspergillus infection may have led to a primary scleritis, followed by a mycotic endophthalmitis. The isolation of a concomitant second infectious agent (the streptococcal infection) could also be due to manipulation of the ocular surface. It could, however, also be an opportunistic infection on an otherwise already traumatised ocular surface. Our conclusion is that despite the relatively rare occurrence infection with Aspergillus should be regarded as a possible cause of any unusual protracted scleritis.