Subpalpebral lavage antibiotic treatment for severe infectious scleritis and keratitis.

OBJECTIVE To report the subpalpebral lavage therapy for the treatment of infectious scleritis and keratitis. METHOD Six patients were admitted for treatment of severe infectious scleritis and keratitis and were initiated on the subpalpebral lavage system after showing no improvement with topical fortified antibiotics. A continuous antibiotic lavage was applied until clinical sterility was achieved and topical steroids were gradually added to control concomitant inflammation. RESULTS All 6 patients had resolution of their infections and achieved a stable ocular surface with no inflammation. One patient required a corneal transplant for active inflammation and corneal thinning, 1 had a transplant for a dense central corneal scar, and 1 patient underwent corneal transplant and cataract extraction. One case was a Pseudomonas keratitis in a blind eye, which rapidly resolved and has remained stable. Four patients required additional surgeries, which included 3 corneal transplants, 2 cataract extractions, and 1 glaucoma aqueous shunt. CONCLUSION Continuous irrigation of the eye can improve scleral penetration of antibiotics. Subpalpebral lavage provides continuous irrigation and may be effective in the treatment of infectious scleritis of a variety of etiologies.