Intravitreal dexamethasone implant — a new treatment for idiopathic posterior scleritis: A case report

BACKGROUND Posterior scleritis is one of the most easily missed and misdiagnosed diseases in ophthalmology.In this case we treated a patient with intravitreal dexamethasone implant that has not been extensively studied before.CASE SUMMARY A 40-year-old female patient who had anxiety,palpitation,and insomnia presented with eye pain and decreased vision in the left eye.An eye examination indicated that her visual acuity(VA)was 40/100.Her left eye presented conjunctival edema,mild exophthalmos,clear cornea,KP(-),and clear aqueous humor.In the fundus,there was a cinerous retinal protuberance.Ultrasonography showed“T-sign”and no systemic association was detected in laboratory examination.One month after injection of dexamethasone implant,the patient exhibited VA of 20/20,fundus serous retinal detachment disappeared,and intraocular pressure of both eyes was at the normal level.CONCLUSION Intravitreal injection of dexamethasone implant may be a safe and effective treatment for patients with idiopathic posterior scleritis.

Monocular posterior scleritis presenting as acute conjunctivitis:A case report

BACKGROUND 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.CASE SUMMARY 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.CONCLUSION 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.

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

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,Bscan,and OCT).