Bilateral posterior scleritis due to giant cell arteritis

Area of Science:

• Ophthalmology
• Rheumatology
• Geriatrics

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting older adults, potentially leading to irreversible vision loss.
• Posterior scleritis, an inflammation of the posterior sclera, can present with non-specific symptoms, often delaying diagnosis.
• Individuals with learning difficulties may have challenges communicating symptoms, further complicating early detection.

Observation:

• A woman in her mid-70s with mild learning difficulty presented with eye symptoms, headache, and shoulder pain.
• Despite consultations in General Practice and Accident & Emergency, her symptoms persisted for 11 days.
• Diagnoses considered included acute angle closure glaucoma and iritis, highlighting the diagnostic challenge.

Findings:

• The patient was diagnosed with bilateral posterior scleritis secondary to giant cell arteritis.
• This case underscores the potential for delayed diagnosis of posterior scleritis due to ambiguous presentation.
• The diagnosis was confirmed after a thorough ophthalmic assessment.

Implications:

• Prompt and thorough assessment of painful red eyes is essential, especially in patients with atypical presentations or communication challenges.
• Recognizing red-flag signs associated with GCA and posterior scleritis can facilitate earlier treatment and improve patient outcomes.
• Awareness of specific guidance for managing visual disturbances in individuals with learning difficulties is vital for healthcare providers.