Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.5030
Peer-review started: March 26, 2020
First decision: August 23, 2020
Revised: September 2, 2020
Accepted: September 28, 2020
Article in press: September 28, 2020
Published online: October 26, 2020
Processing time: 213 Days and 21.7 Hours
Posterior scleritis is a rare inflammatory ocular disease, characterized by severe and painful inflammation of the sclera. It is often misdiagnosed or underdiagnosed, due to its general and varying clinical presentation profile, which primarily involves pain and visual impairment but which can include eyelid edema, choroidal folds, serous retinal detachment, disc edema, hard exudates in fovea and subretinal mass. We report here a case of posterior scleritis, with symptoms of eye pain and red eye, initially misdiagnosed as acute conjunctivitis.
A 56-year-old man presented to a local hospital with complaint of pain and redness in the right eye. The initial diagnosis was acute conjunctivitis and he was given antibiotic eyedrops. Upon week-long continuance of the symptoms despite treatment, he presented to our hospital. Initial examination revealed a shallow anterior chamber in the right eye and vision reduction to 0.6. Further testing by optical coherence tomography, ultrasound biomicroscopy, and fundus photography indicated diagnosis of posterior scleritis. The patient was given methylprednisolone (oral) on a tapered reduction schedule (starting with 70 mg/d). According to the peaks and troughs of symptoms, compound betamethasone injection was administered into the bulb, culminating in discontinuation of the oral corticosteroid. Subsequent optical coherence tomography showed the subretinal fluid near the optic disc to be completely absorbed after treatment.
Posterior scleritis should be among the differential diagnosis of eye pain and redness, and diagnosis requires further ophthalmic accessory examination, such as by optical coherence tomography.
Core Tip: We report here a rare case of posterior scleritis, which was initially misdiagnosed as acute conjunctivitis due its presentation of non-specific clinical features, specifically eye pain and redness. Ophthalmic accessory examinations, such as optical coherence tomography, ultrasound biomicroscopy and fundus photography, should be conducted in the early stage of this disease; this will facilitate making the appropriate differential diagnosis and avoid delay in treatment, which could otherwise lead to the loss of vision.