2. HISTORY
• A 20 yr old female, Resident of Bhiwani, Presented on 11.07.2023
Chief complaints
– LE DOV since 1 month : gradual, progressive, more blurring in center
– LE Redness since 3-4 days : mild, not associated with discharge
/watering / itching
– LE Pain since 3-4 days :gradual ,dull aching ,aggravates on ocular
movements
– No joint pain / stiffness /back pain
– No recent wt. loss /cough/diarrhea / fever /skin lesions
Past history : similar episodes 6 month back, relieved on treatment
No significant family history ,allergy history ,personal history
General examination : WNL
She went to nearby hospital and treated on lines of conjunctivitis ,got some
relief in symptoms but no improvement in vision
3. EXAMINATION
VISUAL ACUITY RE LE
VA 6/9 1/60
PINHOLE 6/6 6/36
RE LE
EYELIDS FLAT FLAT
CONJUNCTIVA GROSSLY NORMAL CCC+ ,TEMPORAL
CONGESTION
CORNEA CLEAR CLEAR
SCLERA GROSSLY NORMAL CONGESTION +
AC Normal in contents
and depth
AC CELLS 1+
PUPIL NO RAPD No RAPD
4. FUNDUS PHOTO
Media looks clear, medium size optic disc vertically oval with healthy NRR,CDR
0.2 :1 , FR dull , ILM Folds seen, SRF inferiorly
5. FFA
On MACULAR 3D OCT , RE findings were unremarkable and OCT of LE revealed loss of
foveal contour, ILM folds , SRF , inferotemporal Retinal detachment, foveal thickness 306
microns
6. B SCAN
B Scan of LE Axial view, gain 20 , characteristic T Sign s/o of fluid in episcleral
space and extending around optic nerve noted along with SRF and focal Retinal
detachment in inferior quadrant. Retinochoroid thickness is 3.31mm noted
8. ON FOLLOW UP
• RA factor ,ANCA, Anti CCP ,ANA : Normal
• ON 15/7/2023 : Plan for PST :40 mg/1mL Triamcinolone injection given in posterior
subtenon space
• ON 23/7/2023 : Patient feeling better and RC thickness reduced ,VA was 6/36 LE, 6/6 p
RE
– Patient started on AZATHIOPRINE 50 MG TDS for 2 weeks after completion of 2
weeks course of oral steroids
• ON 07/08/2023 : Patient feeling better and RC thickness reduced
– After course of 2 weeks of Azathrioprine , VA Improved from 6/36 in LE to 6/12
– ILM folds resolved
– We CST and observation with serial B Scan
9. DISCUSSION
• Posterior scleritis is inflammation of sclera posterior to equator. It can be a
blinding disease if left untreated
• Serial B scans played crucial role in diagnosing and monitoring the results
at regular follow ups.
• Early diagnosis and prompt treatment with topical injection of steroids
and oral immunosuppression lead to visual recovery as was seen in our
case
