Fungal Infectious Necrotizing Scleritis Following Vegetative Ocular Trauma

Infectious necrotizing scleritis (INS) is a rare, vision-threatening condition that often resembles immune-mediated scleritis, leading to delayed diagnosis and inappropriate corticosteroid use. We report a 45-year-old diabetic farmer who developed severe pain, redness, purulent discharge, and progressive visual loss in the right eye 3 weeks after vegetative ocular trauma. Initial treatment with topical corticosteroids failed to improve symptoms. Best-corrected visual acuity was 3/60, and slit-lamp examination revealed localized scleral necrosis with conjunctival ulceration and purulent exudate. Autoimmune investigations were negative. Surgical debridement with microbiological evaluation demonstrated septate fungal hyphae on potassium hydroxide mount, and culture confirmed Aspergillus species. Intensive topical and systemic antifungal therapy with repeated debridement achieved infection control and preserved globe integrity. Corticosteroids were introduced only after microbiological resolution. Residual scleral thinning was noted at follow-up. Early microbiological diagnosis and combined medical-surgical management are essential for favorable outcomes in fungal INS.