A case of posterior scleritis: differential diagnosis of ocular pain

Abstract

Posterior scleritis is a rare cause of ocular pain, due to scleral inflammation, presenting with periocular pain, pain on movement and decreased vision. Although anterior scleritis may be associated with this condition, ocular signs may be absent. We report a case of posterior scleritis, presenting with right-sided ocular and periocular pain, exacerbated by ocular movements, irradiating to the ipsilateral temple and zygoma, not associated with visual disturbances at onset. Diagnosis was made with ultrasonography and confirmed by brain and orbital MRI. Differential diagnosis of facial pain, in particular, affecting the periorbital region, is discussed.In the presence of ocular pain, even in the absence of ocular signs, an ophthalmologic consultation should be performed.

Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis

“…However, these patients typically complain about a slowly progressive, painless visual loss and alterations of the macula or retina are in most cases evident in ophthalmological examination. Posterior scleritis is often also associated with visual loss but in contrast to ON eye pain is the most prominent symptom [Maggioni et al 2007]. The big blind spot syndrome and acute zonal occult outer retinopathy describe other rare ophthalmologic differential diagnosis.…”

Posterior Scleritis Presenting with Angle Closure Glaucoma

“…USG, fundus fluorescein angiography, and CT may be required for differential diagnosis. 4 The USG and CT will show the sub-Tenon effusion and any thickening of the posterior sclera, contributing to a definitive diagnosis. The basic sign in the USG is the "T" sign due to retrobulbar edema.…”

CT and MR Imaging in the Diagnosis of Scleritis

“…The differential diagnosis of scleritis on imaging mainly is tumor, particularly with nodular scleritis, with published cases of globe tumors misdiagnosed as scleritis 14 and scleritis mimicking a choroidal mass. 8,9 In the diffuse form of scleritis, posterior uveitis, diffuse melanoma, and lymphoma are the most relevant differential diagnoses. CT and MR imaging have proved useful in distinguishing these entities.…”