Posterior scleritis

McCluskey, Peter; Watson, Peter; Lightman, Susan; Haybittle, J. L.; Restori, Marie; Branley, Michael

doi:10.1016/s0161-6420(99)90543-2

Cited by 259 publications

(94 citation statements)

References 7 publications

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“…Most metastatic lung cancers to the choroid are amelanotic (99%) with a plateau (55%) or dome (43%) configuration [1]. This atypical flat, diffuse infiltration made the tumor more difficult to visualize ophthalmoscopically, possibly leading to its misidentification as an inflammatory condition, labeled as posterior scleritis [8]. Our case illustrates the importance of ocular pain and the need for a thorough evaluation in patients, especially those with a prior history of cancer.…”

Section: Discussionmentioning

confidence: 99%

Unrelenting Ocular Pain as a Masquerading Symptom of Occult Choroidal Metastasis

et al. 2016

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Purpose: To report a case of chronic eye pain as a presenting feature of choroidal metastasis from lung cancer. Methods: We report the case of a 58-year-old Caucasian woman with stage IV lung adenocarcinoma presenting with an 8-month history of left eye pain and blurred vision. Results: The patient had previously consulted 14 ophthalmologists with varying diagnoses including posterior scleritis and trigeminal neuralgia. Visual acuity at presentation was 20/20 in the right eye and 20/80 in the left eye. Examination of the right eye was normal, while the left eye showed ill-defined flat yellow discoloration of the choroid with overlying shifting subretinal fluid. Ultrasonography demonstrated a dense choroidal thickening measuring 2.6 mm in size and showing subretinal fluid. Enhanced depth imaging optical coherence tomography revealed choroidal thickening with a ‘lumpy bumpy' surface topography consistent with a metastatic choroidal tumor presumably from the patient's lung adenocarcinoma. Fine needle aspiration biopsy followed by treatment was recommended, but the patient declined and later succumbed to metastatic disease. Conclusion: We present a case of chronic eye pain associated with diffuse choroidal thickening from metastatic lung adenocarcinoma that was previously unrecognized and misdiagnosed. This case emphasizes the importance of recognizing pain as a presenting symptom of choroidal metastasis.

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Section: Discussionmentioning

confidence: 99%

Unrelenting Ocular Pain as a Masquerading Symptom of Occult Choroidal Metastasis

et al. 2016

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“…Common associated systemic disorders include rheumatoid arthritis, systemic vasculitis, Wegener’s granulomatosis, Vogt-Koyanagi-Harada disease and relapsing polychondritis [1, 2]. …”

Section: Discussionmentioning

confidence: 99%

“…However, posterior scleritis has not been previously reported in association with HLA B27 haplotype. Although posterior scleritis has been reported in association with ankylosing spondylitis [1, 2] it is not clear whether it is the HLA B27 haplotype that is associated with posterior scleritis or ankylosing spondylitis. In our local series of patients with posterior scleritis, HLA B27 haplotype was seen in 5 (0.10%) of 49 patients [unpubl.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a positive HLA B27 haplotype present mainly with anterior uveitis and anterior scleritis. Although posterior scleritis has been described in association with ankylosing spondylitis [1], we are unaware of any previous reports of an association between posterior scleritis and HLA B27 haplotype. We report 5 patients with posterior scleritis who were found to have a positive HLA B27 haplotype, of which 2 had no underlying systemic disease.…”

Section: Introductionmentioning

confidence: 95%

“…It is most commonly idiopathic but is also found in association with systemic disorders like rheumatoid arthritis [1]. Patients with a positive HLA B27 haplotype present mainly with anterior uveitis and anterior scleritis.…”

Section: Introductionmentioning

confidence: 99%

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Posterior Scleritis and Its Association with HLA B27 Haplotype

Anshu

Chee²

2007

Ophthalmologica

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Background: Posterior scleritis is most commonly idiopathic but is also found in association with systemic disorders like rheumatoid arthritis. HLA B27 spondyloarthropathy manifests itself mainly in the form of anterior uveitis and anterior scleritis. Posterior scleritis has not been previously reported in patients with HLA B27 haplotype. We document the likely association between posterior scleritis and HLA B27 haplotype in a series of 5 patients who presented to the Ocular Inflammation and Immunology Services of the Singapore National Eye Centre. Methods: Retrospective observational case series. The medical records and ultrasound B scans of 5 patients with a diagnosis of posterior scleritis were reviewed. Results: The medical records of 5 patients (4 Chinese and 1 Malay) in the age range of 22–64 years were reviewed. All had unilateral disease (4 in the left eye and 1 in the right eye) at presentation. The most common presenting symptoms were pain (5) and blurring of vision (5); diplopia and proptosis was present in 2 patients. Two patients had anterior scleritis and all had an associated anterior uveitis. Posterior segment findings included optic disc edema (5), macular edema (5), choroidal folds (3), exudative retinal detachment (2) and choroidal effusion (1). All patients had a thickened sclera on serial ultrasound B scan. 2 patients had joint involvement preceding ocular signs and symptoms and were diagnosed to have ankylosing spondylitis. HLAB27 was positive in all our patients. Systemic workup for other diseases was negative. The ocular inflammation responded to a varying combination of topical, periocular and systemic steroids. One of them developed a recurrence of posterior scleritis which resolved with oral steroids. Visual outcome was satisfactory in all but 1 patient who had retinal pigment epithelium atrophy at the macula. Conclusion: Although posterior scleritis has been reported in association with ankylosing spondylitis, it is not clear whether it is the HLAB27 haplotype that is associated with posterior scleritis or ankylosing spondylitis. All our patients were HLAB27 positive but 2 of them did not have an underlying spondyloarthropathy. This suggests the possible association of posterior scleritis with HLAB27 haplotype.

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Long-term Follow-up of Giant Nodular Posterior Scleritis Simulating Choroidal Melanoma

et al. 2000

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41-year-old asymptomatic woman was referred for enucleation of a 7.5-mm-thick intraocular tumor suspected to be choroidal melanoma. The clinical findings combined with imaging studies suggested instead a diagnosis of giant nodular posterior scleritis. A scleral biopsy was performed to confirm the diagnosis. After 12 years of observation, the lesion has remained stable and visual acuity has been preserved. Nodular posterior scleritis can present with no symptoms of pain, redness, or visual disturbance and can remain quiet for many years. It must be clinically differentiated from choroidal melanoma.

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Posterior scleritis

Cited by 259 publications

References 7 publications

Unrelenting Ocular Pain as a Masquerading Symptom of Occult Choroidal Metastasis

Unrelenting Ocular Pain as a Masquerading Symptom of Occult Choroidal Metastasis

Posterior Scleritis and Its Association with HLA B27 Haplotype

Long-term Follow-up of Giant Nodular Posterior Scleritis Simulating Choroidal Melanoma

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