A Rare Case of Pseudomonas Aeruginosa Keratoscleritis: Highlighting Early Diagnosis and Aggressive Treatment

Background: Pseudomonas aeruginosa keratoscleritis (PAK) is an uncommon but aggressive ocular infection that can rapidly threaten vision if not recognized and treated promptly. Case presentation: A 75‑year‑old woman presented with a large corneal epithelial defect, stromal infiltrates, and hypopyon. She was initially managed empirically for fungal keratitis but later diagnosed with PAK following scleral nodule excision and positive cultures for Pseudomonas aeruginosa (P. aeruginosa). Management and outcome: Intensive therapy, including topical and systemic antibiotics, subconjunctival injections, and autologous serum tears, gradually improved corneal ulceration and scleritis. Although her visual acuity remained severely impaired, early initiation of targeted antimicrobial therapy preserved ocular integrity and avoided surgical intervention. Conclusion: PAK is a rare, sight-threatening infection with high morbidity if treatment is delayed. This case highlights the importance of early and accurate diagnosis, together with prompt and aggressive antimicrobial management to prevent complications and preserve the globe.