Posterior scleritis

Atypical posterior scleritis mimicking choroidal melanoma

“…Posterior scleritis may be challenging to diagnose in certain cases as it may present clinically with a subretinal mass due to the localization of the underlying scleral inflammation to a part of the sclera; hence, a wide list of differential diagnoses should be examined thoroughly before reaching a conclusion and proceeding with the treatment. 2 - 7 Posterior scleritis most commonly presents with periocular pain, which is reported to occur in 64% of the cases, unlike our patient, who presented without pain. 5 Few studies in the literature have reported a presentation similar to that of our patient, where posterior scleritis manifested clinically as a subretinal mass, mimicking the appearance of intraocular tumors, such as amelanotic choroidal melanoma; however, ultrasonographic evaluation helped limit the differential diagnosis.…”

“…Posterior scleritis may be challenging to diagnose in certain cases as it may present clinically with a subretinal mass due to the localization of the underlying scleral inflammation to a part of the sclera; hence, a wide list of differential diagnoses should be examined thoroughly before reaching a conclusion and proceeding with the treatment 2-7. Posterior scleritis most commonly presents with periocular pain, which is reported to occur in 64% of the cases, unlike our patient, who presented without pain 5.…”

“…In general, systemic corticosteroids are considered the first-line treatment for posterior scleritis 1,4. On the other hand, locally administered corticosteroids are an effective alternative, with fewer undesirable systemic side-effects 5,7. However, the administration of subconjunctival steroid injection is contraindicated for necrotizing type of scleritis, as it can lead to scleral melting and subsequent perforation 1.…”

“…Other less common features include: macular edema, subretinal fluid, subretinal mass, and disc edema 4,5. The diagnosis of posterior scleritis is based on clinical features, in combination with the findings of essential diagnostic tests, principally the Brightness scan, which usually demonstrates scleral wall thickening and fluid collection in the posterior subtenon space 7. Nevertheless, posterior scleritis may impose diagnostic challenges, despite the availability of such conventional ancillary tests, due to its variable clinical manifestations 1,4.…”

“… 4 , 5 The diagnosis of posterior scleritis is based on clinical features, in combination with the findings of essential diagnostic tests, principally the Brightness scan, which usually demonstrates scleral wall thickening and fluid collection in the posterior subtenon space. 7 Nevertheless, posterior scleritis may impose diagnostic challenges, despite the availability of such conventional ancillary tests, due to its variable clinical manifestations. 1 , 4 Various effective therapeutic modalities currently exist for the management of posterior scleritis, including non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and immunosuppressive drugs.…”