PCR-Confirmed Herpetic Anterior Scleritis in an Adolescent: A Case Report

Abstract

Background: Scleritis is a severe and potentially sight-threatening inflammatory disease of the sclera, most frequently associated with systemic autoimmune disorders. Infectious etiologies are less common but remain clinically significant, particularly those caused by herpes viruses. Early recognition is essential,    as inappropriate management,especially isolated corticosteroid therapy,may worsen the disease course. Case Report: We report the case of a 15-year-old female presenting with a unilateral painful red eye associated with cutaneous herpetic lesions. Best-corrected visual acuity was 20/20 in both eyes. Ocular examination revealed localized nasal conjunctival hyperemia in the left eye without scleral nodules or necrosis. The cornea was clear with preserved corneal sensitivity, and no signs of anterior uveitis were observed. The phenylephrine test demonstrated persistence of redness with partial blanching, suggesting deep vascular involvement. Polymerase chain reaction (PCR) testing for herpes virus was positive, confirming the viral etiology. The patient was treated with systemic antiviral therapy followed by cautious introduction of corticosteroids, with a favorable clinical outcome. Conclusion: Herpetic anterior scleritis may mimic superficial inflammatory conditions such as episcleritis, particularly in early stages. PCR plays a pivotal role in confirming the diagnosis and guiding appropriate management. Prompt antiviral therapy is essential to prevent complications and ensure favorable outcomes.