Bilateral posterior scleritis presenting as acute primary angle closure: A case report

Abstract

BACKGROUND Scleritis is a rare disease and the incidence of bilateral posterior scleritis is even rarer. Unfortunately, misdiagnosis of the latter is common due to its insidious onset, atypical symptoms, and varied manifestations. We report here a case of bilateral posterior scleritis that presented with acute eye pain and intraocular hypertension, and was initially misdiagnosed as acute primary angle closure. Expanding the literature on such cases will not only increase physicians’ awareness but also help to improve accurate diagnosis. CASE SUMMARY A 53-year-old man was referred to our hospital to address a 4-d history of bilateral acute eye pain, headache, and loss of vision, after initial presentation to a local hospital 3 d prior. Our initial examination revealed bilateral cornea edema accompanied by a shallow anterior chamber and visual acuity reduction, with left-eye amblyopia (> 30 years). There was bilateral hypertension (by intraocular pressure: 28 mmHg in right, 34 mmHg in left) and normal fundi. Accordingly, acute primary angle closure was diagnosed. Miotics and ocular hypotensive drugs were prescribed, but the symptoms continued to worsen over the 3-d treatment course. Further imaging examinations ( i.e. , anterior segment photography and ultrasonography) indicated a diagnosis of bilateral posterior scleritis. Methylprednisolone, topical atropine, and steroid eye drops were prescribed along with intraocular pressure-lowering agents. Subsequent optical coherence tomography (OCT) showed gradual improvements in subretinal fluid under the sensory retina, thickened sclera, and ciliary body detachment. CONCLUSION Bilateral posterior scleritis can lead to secondary acute angle closure. Diagnosis requires ophthalmic accessory examinations ( i.e ., ultrasound biomicroscopy, B-scan, and OCT).

Posterior Scleritis: A Case Report and Literature Review of the Management of the Condition

“…Females are more likely to develop this disease, and the mean age of presentation is around 45 years [1][2][3]. It is usually unilateral but rarely can affect both eyes in up to a third of cases [4]. Symptoms of posterior scleritis include eye pain, headache, pain with ocular movements, and loss of vision if not treated timely [1].…”

“…Clinical manifestations are very nonspecific and are usually monocular. About one-third of cases are binocular, making bilateral disease even rarer [ 4 ]. Symptoms usually include ocular pain, which is exacerbated by ocular movements, headache, and loss of vision [ 1 ].…”