Posterior scleritis mimicking orbital cellulitis

Abstract

In 2008, an 88-year-old woman with a background of well controlled systemic hypertension and high myopia presented to an emergency department with a 5-day history of left periorbital swelling, erythema and mild discomfort, without visual loss. She was seen in the ophthalmology clinic on the same day. Her visual acuity was 6/12 in each eye. She was afebrile, with left upper and lower lid erythema, oedema closing the palpebral fissure, and conjunctival and scleral injection. Slit-lamp biomicroscopy revealed normal anterior chambers; clear, well centred intraocular lens implants from previous uncomplicated cataract surgery; and posterior staphylomata (an incidental finding of bulging of the globe seen in some highly myopic patients). A computed tomography (CT) scan revealed left periorbital soft tissue thickening, with stranding confined to the preseptal area.