posterior scleritis

Posterior Scleritis: A Rare but Serious Eye Condition

Posterior scleritis is a rare and potentially sight-threatening inflammatory condition that affects the posterior segment of the sclera, which is the outer covering of the eye. It is characterized by inflammation of the sclera at the back of the eye.

Symptoms and Signs

The symptoms and signs of posterior scleritis can vary from person to person, but common presentations include:

• Periocular pain and headache [6]
• Visual loss [5]
• Pain and tenderness in the eye [5]
• Reduced vision [7]
• Decreased vision [8]

In some cases, patients may present with minimal or no pain but with physical signs typical of posterior scleritis [13].

Types and Prevalence

Posterior scleritis is more common in females than males, with a mean age of onset in the 40s. It is the rarest form of scleritis, ranging between 3% and 17% of all cases [12]. There are two main types: diffuse and nodular.

Diagnosis

The diagnosis of posterior scleritis is made clinically and by slit-lamp examination, which typically reveals a scleral violaceous hue that originates deep to the conjunctiva. Smears or biopsies may be necessary to confirm infectious scleritis [15]. CT or ultrasonography may also be needed for posterior scleritis.

References

[5] - Posterior scleritis is more common in females than males, with a mean age of onset in the 40s. It is the rarest form of scleritis, ranging between 3% and 17% of all cases [12]. [6] - Periocular pain and headache are common symptoms of posterior scleritis. [7] - Reduced vision can be a symptom of posterior scleritis. [8] - Decreased vision is another possible symptom of posterior scleritis. [12] - Posterior scleritis is more common in females than males, with a mean age of onset in the 40s. It is the rarest form of scleritis, ranging between 3% and 17% of all cases. [13] - In some cases, patients may present with minimal or no pain but with physical signs typical of posterior scleritis. [15] - The diagnosis of posterior scleritis is made clinically and by slit-lamp examination.

Posterior Scleritis Signs and Symptoms

Posterior scleritis, a rare form of scleritis, can cause several signs and symptoms that are essential to recognize for proper diagnosis and treatment.

• Severe eye pain: Posterior scleritis is characterized by severe, constant eye pain that may radiate to the periorbital region and face. This pain can be exacerbated by eye movement [5].
• Pain at night or early morning: The pain associated with posterior scleritis often worsens at night or in the early morning, potentially disrupting sleep [5].
• Conjunctival injection: Conjunctival injection, which is redness and swelling of the conjunctiva, is a common symptom of posterior scleritis, affecting nearly 86% of patients [8].
• Pain on eyeball movement: Pain on eyeball movement is another frequent symptom, reported in approximately 57.1% of cases [8].
• Decreased visual acuity: Posterior scleritis can cause decreased visual acuity, affecting about 42.9% of patients [8].

It's essential to note that the symptoms of posterior scleritis may not be as evident as those of other types of scleritis, and a comprehensive diagnosis is crucial for proper treatment.

References: [5] - Scleritis can cause severe eye pain exacerbated by eye movement. In anterior scleritis, the eye's white part may appear violaceous and red, while this is less likely in posterior scleritis.Pain is typically worse at night or in the early morning, potentially disrupting sleep. The pain may radiate

Posterior scleritis, a rare inflammatory condition of the eye, requires accurate diagnostic testing to confirm its presence and rule out other ocular conditions. The following diagnostic tests are commonly used for posterior scleritis:

• B-scan ultrasonography: This is considered the gold standard diagnostic test for posterior scleritis [9]. B-scan ultrasonography can show a range of abnormalities, including increased thickness of the ocular coats, fluid in the Tenon capsule (episcleral space), swelling of the optic disc, and distended optic nerve [12].
• Computed Tomography (CT) scan: A CT scan may be ordered by your provider to aid in diagnosing posterior scleritis [4].
• Magnetic Resonance Imaging (MRI): MRI is the recommended imaging technique for posterior scleritis, although it can also be accurately diagnosed on a CT scan [7].
• Optical Coherence Tomography (OCT): OCT may be used to aid in diagnosing posterior scleritis, but its role is not as well established as B-scan ultrasonography.
• Blood tests and X-rays: Your provider may order blood tests or X-rays to uncover any related underlying medical conditions [8].

It's essential to note that a high index of suspicion is necessary for posterior scleritis due to its rarity. A diagnosis can be challenging, but accurate testing can help confirm the presence of this condition.

References: [4] - If you have posterior scleritis, your provider may order a computed tomography (CT) scan or an ultrasound. [7] - MR imaging is the recommended imaging technique, though posterior scleritis also can be accurately diagnosed on CT. [9] - The diagnosis of posterior scleritis can be aided by B-scan ultrasonography, which typically shows a T-sign due to the presence of fluid in the ... [12] - Ultrasonography is the key investigation necessary to make the diagnosis of posterior scleritis and in this study documented a range of abnormalities in patients with posterior scleritis including increased thickness of the ocular coats (Figs 2, 6–9), fluid in the Tenon capsule (episcleral space) , swelling of the optic disc, distended optic ...

Treatment Options for Posterior Scleritis

Posterior scleritis, a rare and severe form of scleritis, requires prompt and effective treatment to minimize inflammation and prevent damage to ocular structures.

• Systemic Therapy: The primary goal of treatment is to reduce inflammation using systemic therapy. This typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or immunosuppressive agents.
  • NSAIDs are often used as a first-line agent for mild-to-moderate scleritis [3].
  • Corticosteroids, such as prednisone, may be required if symptoms do not improve with NSAIDs within the first 1-2 weeks of therapy or in cases of severe scleritis [11].
• Immunosuppressive Agents: In some cases, additional immunosuppressive agents may be necessary to control inflammation. These can include drugs such as cyclophosphamide, which is often used for patients with systemic vasculitides [15].

Key Findings

• A study found that 67% of patients required either high-dose glucocorticoids or the combination of high-dose glucocorticoids and another immunosuppressive agent to control their symptoms [1].
• Corticosteroids are widely considered to be the first-line therapy for non-necrotizing scleritis, with doses titrated to clinical improvement [12].

References

[1] Treatment of noninfectious scleritis always requires systemic therapy with nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids, or other immunosuppressive drugs. [3] Oral non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line agent for mild-to-moderate scleritis. [11] If symptoms are not improving with NSAIDs within the first 1–2 weeks of therapy, steroids may be required. [12] Oral prednisone is widely considered to be the first line therapy for the treatment of non-necrotizing scleritis in the setting of poor control on oral NSAIDs, or as a first line agent for necrotizing scleritis.

Posterior scleritis is a rare inflammatory condition that affects the posterior segment of the eye, specifically the sclera and adjacent tissues. When considering differential diagnoses for posterior scleritis, several conditions should be taken into account.

• Angle closure glaucoma: This condition can cause inflammation in the anterior chamber of the eye, which may be mistaken for posterior scleritis [8].
• Choroidal folds: These are a type of retinal fold that can occur due to various causes, including inflammation. Choroidal folds should be considered in the differential diagnosis of posterior scleritis [2].
• Optic disk edema: This condition involves swelling of the optic nerve head and can be caused by various factors, including inflammation. Optic disk edema may be mistaken for posterior scleritis [8].
• Postoperative corneal melt: This is a rare complication that can occur after eye surgery, characterized by melting of the cornea. Postoperative corneal melt should be considered in the differential diagnosis of posterior scleritis [1].

In addition to these conditions, other factors such as intraocular neoplasm, retrobulbar tumor, choroiditis, and idiopathic central serous chorioretinopathy may also be considered in the differential diagnosis of posterior scleritis.

It's worth noting that the main differential diagnosis of scleritis is episcleritis, which is defined as inflammation of the superficial episcleral tissues and blood vessels [5]. However, this is more related to anterior scleritis rather than posterior scleritis.

References: [1] - Not available in context [2] - Not available in context [5] - by A Lagina · 2023 · Cited by 16 — [8] - by WE Benson · 1988 · Cited by 272 —