ABSTRACT
Introduction: Conjunctivitis, keratoconjunctivitis, and episcleritis are known ocular surface manifestations of coronavirus disease. Case presentation: A 56-year-old male patient experienced red eye two days after being released from the COVID department. Two weeks later developed nodular scleritis. Ultrasound biomicroscopy raised the possibility of a foreign body or helminth; however, this was not confirmed during the surgical exploration. From an intraoperatively obtained sample, methicillin-resistant Staphylococcus aureus grew, while coronavirus could not be detected. Systemic work-up yielded negative results except for the Quantiferon gold test, but as histology showed granulation tissue, not granulomatous inflammation, it was unlikely that Mycobacterium pneumoniae had a role in ocular inflammation. After targeted local antibiotic therapy, the inflammation resolved slowly over the next five months. Conclusions: Thorough systematic workup, surgical exploration, and sample collection were necessary to determine the exact etiology, where only an indirect connection came to light with the COVID infection itself. To the best of our knowledge, there have been no previously published attempts to detect SARS-CoV-2 in scleral inflammatory tissue.