Exudative retinal detachment and optic disc swelling in the course of posterior scleritis: case study and literature review

Abstract

Objectives: The objective of the present paper is to present a rare case of posterior scleritis with exudative retinal detachment and optic disc oedema.
 Materials: The paper discusses a case of a 28-year-old patient with unilateral posterior scleritis, exudative retinal detachment and optic disc oedema. The patient presented with reduced visual acuity and inflammation within his right eyeball coat.
 Test results: Upon admission, retinal detachment in all quadrants was diagnosed, with subretinal exudate, choroidal folds, but no pathology involving the anterior segment. B projection ultrasound revealed thickening of the posterior sclera of around 2.0 mm and complete retinal detachment in the right eye. Visual acuity results were OD = 1/50 Sc, OS = 45/50 Sc. Elevated intraocular pressure of the right eye was detected at 44.0 mmHg A CT scan of the orbits with contrast revealed significant asymmetry of the eyeballs (right 22 × 22 mm, left 21 × 21 mm) as well as posterior thickening of the right eyeball coat to 2.0 mm. On top of that, on the second day of the patient’s hospital stay, an ophthalmic exam showed obscured borders of the right optic nerve. Systemic treatment was initiated, comprising steroids, non-steroidal anti-inflammatory drugs and intraocular pressure lowering drugs. Additionally, topical treatment was provided with regard to the right eye. A number of laboratory tests were carried out to rule out systemic diseases that could have caused posterior scleritis. After discharge, the patient received follow up care from the hospital’s ophthalmology clinic and remained on topical and systemic steroids. Oral systemic steroid therapy was maintained over a period of a few months, with gradual dose reduction. At follow-up visits, his visual acuity remained stable at OD = 40/50 Sc, OS = 45/50 Sc.
 Conclusions: Posterior scleritis is a condition that requires prompt diagnosis and systemic treatment.