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Posterior scleritis in children: clinical features and treatment
Chui Ming Gemmy Cheung1, Soon-Phaik Chee
1Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.
Insights
Pediatric posterior scleritis presents with uveitis and disc swelling, often requiring long-term immunosuppression for favorable visual outcomes. B-scan ultrasound T-sign confirms diagnosis, with systemic associations being rare.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Rheumatology
Background:
- Posterior scleritis is an inflammatory eye condition that can affect vision.
- Understanding its presentation and treatment in children is crucial for effective management.
- Limited data exists comparing pediatric and adult cases.
Purpose of the Study:
- To summarize clinical findings and treatment responses in pediatric posterior scleritis.
- To compare these features with adult posterior scleritis cases.
- To evaluate the diagnostic utility of B-scan ultrasound and long-term outcomes.
Main Methods:
- Retrospective interventional case series of 20 eyes from 13 pediatric patients (aged 5-16 years).
- Clinical features, investigations (including B-scan ultrasound), treatments, and visual outcomes were analyzed.
- Standard care protocols for scleritis management were followed.
Main Results:
- Common findings included anterior uveitis (80%), optic disc swelling (95%), and retinal striae (85%).
- The B-scan ultrasound T-sign was positive in all cases.
- While initial resolution was achieved with corticosteroids in most, 84.6% required immunosuppressants due to recurrence or intolerance, with a median final vision of 20/20 at 1 year.
- No underlying connective tissue disorders were diagnosed.
Conclusions:
- Posterior scleritis in children commonly presents with anterior uveitis, disc swelling, and retinal striae.
- B-scan ultrasound T-sign is a key diagnostic marker.
- Systemic associations are infrequent.
- Aggressive treatment with corticosteroids and often long-term immunosuppression leads to favorable visual outcomes, though recurrence is common.
Objective:
To summarize the clinical findings and treatment response in posterior scleritis affecting children and to compare these features with posterior scleritis affecting adults.
Design:
Retrospective interventional case series.
Participants:
Twenty eyes of 13 patients aged younger than 18 years who were diagnosed with posterior scleritis in a tertiary referral center.
Intervention:
Investigations and treatment were according to standard care, following published recommendations for scleritis.
Main Outcome Measures:
Clinical features, investigation results, treatment received, and visual outcome were studied.
Results:
Twenty eyes of 13 patients (aged 5-16 years, median 11.53 years; 8 female, 5 male) were included. Scleritis was unilateral in 6 cases and bilateral in 7 cases at presentation. The median presenting vision was 20/30. All eyes had T-sign demonstrable on B-scan ultrasound. Concurrent anterior segment signs included anterior uveitis (80.0%) and anterior scleritis (20.0%). Posterior segment signs included optic disc swelling (95.0%) and retinal striae (85.0%). No underlying connective tissue disorder was diagnosed in any patient. Scleritis resolved with oral nonsteroidal anti-inflammatory agent alone in 1 patient (8%). Twelve patients (92.3%) received oral corticosteroid. Immunosuppressive agents were required in 11 patients (84.6%) because of relapse or intolerance to corticosteroid. The median final vision at 1 year was 20/20. Seven patients (63.6%) remained on immunosuppression at latest follow-up (median 4 years).
Conclusions:
Common features of posterior scleritis include concurrent anterior uveitis, disc swelling, and retinal striae. B-scan ultrasound demonstrating T-sign was the most useful confirmatory investigation in all cases. Systemic association is uncommon. Aggressive therapy with systemic corticosteroid achieves resolution mostly within the first year. Long-term immunosuppression is often required to prevent recurrence. Visual outcome is favorable.
Financial Disclosure(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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