Infectious scleritis (IS) is a rare and severe ocular disorder responsible for approximately 5%-15% of all scleritis cases. It is often associated with a poor prognosis due to its similar clinical presentation to autoimmune scleritis, resulting in a delayed diagnosis and treatment. Therefore, differentiating between infectious and noninfectious entities is critical. Several details extracted from the patient's history and clinical examination can raise suspicion for infection. The most common predisposing factor is previous ocular surgery, especially pterygium, cataract, and vitreoretinal surgeries. Ocular trauma, poor contact lens hygiene, "eye-whitening" procedures, and subtenon triamcinolone injections have also been implicated. Clinical features of infection include the presence of scleral necrosis, hypopyon, unifocal or multifocal scleral abscesses, and mucopurulent discharge. Thorough diagnostic testing is essential before excluding infection as a possibility. Empiric broad-spectrum topical and systemic antibiotic therapy should be initiated while awaiting laboratory results and adjusted accordingly. Most IS cases require both aggressive medical and surgical treatment, and various studies have reported favorable outcomes with this combination. At this time, there is no consensus on the management of this severe ocular condition, and future studies are needed to establish clear treatment guidelines.

中文翻译：

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传染性巩膜炎：病理生理学、诊断和管理。

传染性巩膜炎 (IS) 是一种罕见且严重的眼部疾病，约占所有巩膜炎病例的 5%-15%。由于其临床表现与自身免疫性巩膜炎相似，因此通常与预后不良有关，导致诊断和治疗延迟。因此，区分传染性和非传染性实体至关重要。从患者的病史和临​​床检查中提取的一些细节可以引起对感染的怀疑。最常见的诱发因素是既往眼科手术史，尤其是翼状胬肉、白内障和玻璃体视网膜手术。眼外伤、隐形眼镜卫生差、“眼睛美白”程序和subtenon曲安奈德注射也有牵连。感染的临床特征包括巩膜坏死、前房积脓、单灶性或多灶性巩膜脓肿和粘液脓性分泌物。在排除感染的可能性之前，必须进行彻底的诊断测试。应在等待实验室结果期间开始经验性广谱局部和全身抗生素治疗并进行相应调整。大多数 IS 病例需要积极的药物治疗和手术治疗，并且各种研究报告了这种组合的有利结果。目前，对于这种严重眼部疾病的管理还没有达成共识，需要未来的研究来建立明确的治疗指南。在等待实验室结果时应开始经验性广谱局部和全身抗生素治疗并进行相应调整。大多数 IS 病例需要积极的药物治疗和手术治疗，并且各种研究报告了这种组合的有利结果。目前，对于这种严重眼部疾病的管理还没有达成共识，需要未来的研究来建立明确的治疗指南。应在等待实验室结果期间开始经验性广谱局部和全身抗生素治疗并进行相应调整。大多数 IS 病例需要积极的药物治疗和手术治疗，并且各种研究报告了这种组合的有利结果。目前，对于这种严重眼部疾病的管理还没有达成共识，需要未来的研究来建立明确的治疗指南。