Challenges In The Management Of Sclerouveitis And Pyomyositis Of Extraocular Muscles Secondary To Buckle Exposure : An Inusual Presentation

Published 2025 - 43rd Congress of the ESCRS

Reference: PO212 | Type: Case Report | DOI: 10.82333/2anb-0r83

Authors: Jorge Duque García* ¹ , Inés Hernanz Rodríguez ¹ , June Artaechevarría Artieda ¹ , Lourdes Salgueiro Tielas ¹ , Henrikh Skiba ¹ , Luis García Onrubia ¹

¹FUNDACION JIMENEZ DIAZ,Madrid,Spain

Purpose

To highlight the management and surgical challenges of diffuse unillateral sclerouveitis with conjunctival discharge secondary to unnoticed scleral buckle extrusion, in the context of recent travel and drugs consumption.

Setting

Tertiary referral hospital Fundación Jiménez Díaz, Madrid, Spain.

Report of case

A 56yo male presented to the A&E with discomfort and swelling in his left eye (OS) after volunteering in a south American country where he suffered from self-limited diarrhea.

His past history included bilateral retinal detachment (RD) with scleral buckle and an iris-claw intraocular lens implant in OS. Best-corrected visual acuity (BCVA) was hand movements in OD and 20/50 in OS.

Ocular examination under slit-lamp biomicroscopy showed nasal and superior scleritis with focal swelling and two areas of buckle exposure. The cornea was clear with pancorneal whitish stellate retrokeratic precipitates and 1+ cells in anterior chamber.

Intraocular pressure (IOP) was within normal limits. No vitritis or other posterior segment signs of inflammation were detected.

Conjunctival swabs for bacterial culture and viral CRP were performed. He was initiated on naproxen 550mg bd, valacyclovir 1g tid and moxifloxacin 400mg od, along with topical steroids and topical moxifloxacin. Extensive approach for systemic or inmune-mediated diseases were negative. The patient underwent scleral buckle explant with drainage of two intramuscle abscesses in the medial and inferior rectus. Multiple swabs of the intramuscular exudative material were obtained, with negative results for viruses, bacteria and fungus. MRI confirmed localized anterior scleritis without orbital necrosis. The patient presented a positive postoperative evolution.

Conclusion/Take home message

This case presents a complex scenario of unilateral diffuse sclerouveitis and pyomyositis due to scleral buckle exposure. Pyomyositis, a bacterial infection leading to abscess formation, is rare in extraocular muscles and usually affects immunosuppressed individuals. Staphylococcus aureus is the most common cause.

Diagnosis requires ruling out local and systemic infections, especially in high-risk patients, as well as underlying inflammatory diseases. Management involves removing the predisposing factor, draining abscesses, and administering broad-spectrum antibiotics and immunomodulatory therapy to protect ocular integrity and function.