At presentation, slitlamp examination showed conjunctival congestion
with a 2 × 2-mm scleral nodule surrounded by episcleral vessels (Figure 1A). Other ocular findings were unremarkable.
Infectious scleritis was suspected. She was placed on a regimen of fortified
topical cefazolin sodium (25 mg/mL) and gentamicin sulfate (14 mg/mL) every
hour and systemic gentamicin sulfate, (60 mg) every 8 hours. On the next day,
we performed peritomy to verify the scleral nodule. Cultures were obtained,
and the necrotic sclera was debrided and irrigated with gentamicin. A gram
stain of the scleral nodule showed gram-negative rods (Figure 2). The culture report disclosed heavy growth of Serratia marcescens that was sensitive to gentamicin, amikacin, ciprofloxacin,
piperacillin sodium, imipenem, ceftizoxime sodium, and ceftazidime, but resistant
to cefuroxime, ampicillin, and cephalothin sodium. Therapy with topical and
systemic gentamicin was continued, then tapered during the next 2 weeks until
the lesion was resolved (Figure 1B).
No recurrence or visual impairment was found during the 1-year follow-up.