Título / Title

IDIOPATHIC POSTERIOR SCLERITIS: FOLLOW-UP OF AN EFFECTIVELY HANDLED CASE

Introdução / Purpose

To report a case with idiopathic posterior scleritis associated to serous retinal detachment.

Material e Método / Methods

Case report.

Resultados / Results

A 19-years-old black female, presents with the main complaint of severe ocular pain and vision loss on left eye (OS), associated with nape pain. Past medical history was unremarkable. The best corrected visual acuity (BCVA) was 20/20 on right eye (OD) and 20/200 on OS. Anterior segment biomicroscopy on both eyes (OU) were unremarkable. The fundus examination revealed no alterations on OD and edema and hyperemia of optic disc, besides serous retinal detachment including the macula on OS (Figures 1, 2).
The patient underwent to a laboratory and imaging investigation to exclude other diseases, including infectious etiologies. All came out within the normal ranges. Ultrassonography showed increased scleral thickness without the T Sign (Figure 3). Idiopathic posterior scleritis was established and treatment with pulse therapy with intravenous methylprednisolone for 3 days was initiated followed by oral prednisone (60mg/day).
After 12 days of pulse therapy the fundus findings improved, with complete resolution of the retinal detachment (Figure 4), and the BCVA was 20/30. Two months after, the BCVA was 20/20.

Discussão e Conclusões / Conclusion

Posterior scleritis is often misdiagnosed due to its clinical polymorphism. More commonly affects middle-aged women, which differs from our case. It may be associated with inflammatory or infectious diseases, but 55% is considered idiopathic. Ocular ultrasound helps in diagnosis by showing the characteristic T-signal in 30% of the cases and increased scleral thickness in 80%. Appropriate treatment should be prompted started to ensure a better prognosis.

Palavras Chave

Scleritis; Scleral Diseases; Pulse Therapy, Drug.