Indian Journal of Ophthalmology

PHOTO ESSAY
Year
: 2020  |  Volume : 68  |  Issue : 4  |  Page : 647--649

Retinochoroidal fold with severe discedema in a case of posterior scleritis


Devesh Kumawat, Rohan Chawla, Nasiq Hasan 
 Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Rohan Chawla
Room No. S3, First Floor, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India




How to cite this article:
Kumawat D, Chawla R, Hasan N. Retinochoroidal fold with severe discedema in a case of posterior scleritis.Indian J Ophthalmol 2020;68:647-649


How to cite this URL:
Kumawat D, Chawla R, Hasan N. Retinochoroidal fold with severe discedema in a case of posterior scleritis. Indian J Ophthalmol [serial online] 2020 [cited 2024 Mar 29 ];68:647-649
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2020/68/4/647/280786


Full Text



A 14-year-old male patient presented with acute-onset painful diminution of vision and redness in left eye for past 1 week. The left eye had visual acuity of 20/80, relative afferent pupillary defect, some limitation of abduction, mild proptosis, diffuse conjunctival congestion, 2+ anterior chamber cells, few retrolental cells, severe disc edema [Figure 1]a, annular white peripapillary fold (likely sclerachoroidal infolding), and radiating peripapillary retinochoroidal folds [Figure 1]a. The right eye examination was unremarkable. The possible differentials included posterior scleritis or orbital inflammatory pseudotumor.[1],[2]{Figure 1}

Ultrasonography (USG) B scan showed sclerochoroidal thickening at posterior pole and a positive “T” sign [Figure 1]b. The architecture of posterior pole was distorted on swept source optical coherence tomography (SS-OCT, DRI, Triton, Topcon Inc.) [Figure 1]c. Contrast-enhanced magnetic resonance imaging of orbit revealed posterior scleral thickening with postcontrast enhancement, normal extraocular muscles, and preserved fat planes. A diagnosis of left eye diffuse posterior scleritis with coexistent anterior uveitis was made.

After systemic evaluation, the patient was started on oral corticosteroids, topical steroids, and topical cycloplegic. At 1 week, visual acuity improved to 20/30. Disc edema and peripapillary retinochoroidal folds had nearly disappeared [Figure 2]a. USG B scan showed a near-resolution of “T” sign [Figure 2]b. SS-OCT showed a significant decrease in disc elevation [Figure 2]c. Oral and topical steroids were gradually tapered over 6 weeks. At the last visit (2 months), corrected distance visual acuity (CDVA) was 20/20 in left eye with normal optic disc and peripapillary retina.{Figure 2}

Posterior scleritis often presents with disc edema, circumferential choroidal folds, and retinal straie.[1],[3],[4] The present case was unusual as it had pathological disc elevation and marked annular tissue infolding around the disc. Therefore, it was imperative to rule out compressive intraorbital lesions with imaging. The involvement of extraocular muscles and fat planes was also not evident which ruled out any significant component of pseudotumor. Posterior scleritis needs urgent treatment with systemic steroids.[1],[3] A rapid and thorough clinical examination and orbital imaging is therefore required in such cases to reach a diagnosis and start appropriate treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Benson WE. Posterior scleritis. Surv Ophthalmol 1988;32:297-316.
2Chaudhry IA, Shamsi FA, Arat YO, Riley FC. Orbital pseudotumor: distinct diagnostic features and management. Middle East Afr J Ophthalmol 2008;15:17-27.
3Machado D de O, Curi AL, Bessa TF, Campos WR, Oréfice F. [Posterior scleritis: clinical features, systemic association, treatment and evolution of 23 patients]. Arq Bras Oftalmol 2009;72:321-6.
4Biswas J, Mittal S, Ganesh SK, Shetty NS, Gopal L. Posterior scleritis: Clinical profile and imaging characteristics. Indian J Ophthalmol 1998;46:195.