Posterior scleritis - Retina Club : Retina Club

Figure 1. Color retinography showing multiple serous retinal detachments and choroidal folds in the left eye.

Figure 2. Follow-up color retinography after prednisone treatment showing resolution of serous retinal detachments and choroidal folds in the left eye.

Figure 3. Increased scleral thickness and fluid accumulation in the adjacent sub-Tenon space, forming the T sign.

Description

Posterior scleritis is the least common form of scleritis and is defined as inflammation of the sclera after the insertion of the rectus muscles. It may present with serous retinal detachments, choroid folds, or both. It is usually accompanied by pain with eye movement and decreased visual acuity. Scleritis is associated with connective tissue diseases, the most common being rheumatoid arthritis. It may also be caused by infections, surgery, or trauma. It can be treated with oral nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or immunomodulatory agents.

Comments

Indication

A 22-year-old woman presented with ocular pain and loss of vision in her left eye. Examination revealed choroid folds and multiple serous retinal detachments, and ultrasound revealed increased scleral thickness and fluid accumulation in the adjacent sub-Tenon space (T sign). Once an infectious cause was ruled out, treatment with prednisone (1 mg/kg/day) was started until the condition resolved, and then continued on a descending regimen. The patient's visual acuity improved from 0.1 to 1 (decimal scale, Snellen). During follow-up, associated systemic pathology was ruled out despite the ANA being positive.