Posttraumatic Aspergillus Scleritis

Fungus infection involving the sclera is extremely rare. we are reporting a 53 year –old man who developed post-traumatic Aspergillus fungal scleritis after trauma by branch of a tree diagnosis was made after tissue biopsy, successful outcome was achieved by scleral debridement, dura patch graft, and topical Amphotericine B. The patient had no signs of infection for 6 months after discontinuation of medication. Key word: Scleritis, fungus, Aspergillus, dura graft. From the Department of ophthalmology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia Correspondence to Dr Essam A. Osman FRCS, Department of Ophthalmology, King Abdulaziz University Hospital, P.O Box 245, Riyadh, Kingdom of Saudi Arabia Telephon: 00966-1-4775731; Fax: 00-966-1-4775741; Email: essamosman @hotmail.com PDF created with pdfFactory Pro trial version www.pdffactory.com Post traumatic fungal scleritis is uncommon. A few cases has been reported after trauma. Brunet and Stulting reported a 40 year-old man struck in his left eye by a flying chip of wood ,a diagnosis of episcleritis was made and a Sporthrix schenckii a dimorphic fungus was identified and was treated with saturated solution of potassium iodide. Another case of traumatic scleritis by branch of a tree was reported by Rodriguez-Ares, diagnosis was established after biopsy of a scleral nodule which showed hyphal fragment and cultures were positive for Aspergillus fumigatus.The patient was successfully treated with systemic antifungal drugs, cryotherapy, and dura graft. Post-operative fungal scleritis has been reported after pterygium excisionretinal detachment surgery, cataract surgery, glaucoma surgery, and in association with systemic fungus infection. Aspergillus species are saprophytic moulds. Most live in the environment without causing disease. Aspergillus fumigatus is the commonest human pathogen. Other species causing infection include A. nigar and A. flavus .and A.nidulans. Invasive aspergillosis occurs mainly in immunecompromised patient, and is often life threatening. The hyphae of Aspergillus can be detected microbiologically in a KOH or calcofluor white showing typical Aspergillus fruiting head showing a conidiophore, swollen vesicle, and phialides. The outcome of management of fungus scleral infection depends on early detection, type of organism, and modality of intervention. In this report we are prescribing 53year-old man developed posttraumatic aspergillus scleritis, diagnosis was made after tissue biopsy and treated successfully with scleral debridment, dura path graft and topical Amphotericine B. To the best of our knowledge there are only two pervious cases reported as post traumatic fungal scleritis.