Posterior Scleritis with Inflammatory Retinal Detachment

A 14-year-old African American male presented to the emergency department with worsening left eye redness, swelling, and vision loss over the preceding three days. History was notable for similar eye redness and swelling without vision loss four months earlier, which improved following a brief course of prednisone. He endorsed mild eye irritation and tearing with bright lights. There was no history of fever, respiratory symptoms or trauma. Mother was medicating patient with leftover antibiotic eye drops x3 days without improvement. Physical examination on presentation notable for proptosis of left eye, lid, and periorbital swelling, mild scleral injection, and central vision loss in affected eye (20/200 OS, 20/25 OD). Extraocular movements and pupillary exam were normal. No corneal fluorescein uptake, abnormal cell, flare, or siedel sign were seen during slit lamp exam. Eye pressures were 24 mmHg in both eyes. Bedside ultrasonography was performed (Figure 1 showing retinal detachment, Ultrasound Video 2 showing detachment in orbital scan).