Bilateral posterior scleritis: an idiopathic painless presentation

Area of Science:

• Ophthalmology
• Rheumatology

Background:

• Posterior scleritis is an inflammation of the posterior uvea.
• Ocular pain is a common symptom of posterior scleritis.

Observation:

• An 18-year-old male presented with decreased vision but no ocular pain.
• Ophthalmologic examination revealed bilateral exudative retinal detachment.
• Imaging studies including optical coherence tomography (OCT) and ultrasonography showed diffuse posterior scleral thickening and serous retinal detachment.

Findings:

• Diagnostic workup, including laboratory tests and imaging, ruled out systemic disease.
• The patient showed a positive response to oral prednisolone treatment.
• The findings suggest a presentation of posterior scleritis without the typical symptom of pain.

Implications:

• This case broadens the clinical spectrum of posterior scleritis.
• It emphasizes the need for a high index of suspicion for posterior scleritis in cases of unexplained vision loss, even in the absence of pain.
• Early diagnosis and treatment are crucial to prevent vision-threatening complications.