Posterior Scleritis: Analysis of Epidemiology, Clinical Factors, and Risk of Recurrence in a Cohort of 114 Patients

Abstract

Posterior scleritis is an uncommon disease causing pain and visual loss. In around 40% of the cases, it can be associated with other systemic diseases. Median time to relapse was 210 days. Relapses may occur in around 1 in 3 patients, with an incidence rate of 15.81% per person/year.

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 3,6,9,10.…”

“…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 3,6,9,10. Such studies highlight the importance of B-scan or Amplitude scan as crucial diagnostic tests 4,5. Delayed diagnosis may mislead treatment, and expose the patient to vision-threatening and possibly life-threating complications if the underlying systemic illnesses are not diagnosed early in the course of the disease 4…”

“…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.…”

“…It usually occurs as an isolated ocular disease, yet 19.4% to 37.7% cases may be associated with systemic diseases, such as Wegener granulomatosis, systemic lupus erythematosus, and rheumatoid arthritis 4,5. Posterior scleritis manifests with a wide array of clinical presentations; thus, it may mimic multiple benign and malignant conditions affecting the posterior ocular structures 1-10.…”

“…Posterior segment examination usually shows significant serous (exudative) retinal detachment and/or choroidal fold. 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.…”