Anterior and Posterior Scleritis

Joshua Levinson, MD Valerie Biousse, MD

External Photograph

Note the injection of scleral and episcleral vessels with edema of the scleral wall

Figure 1

Fundus Photograph

Unilateral optic disk edema in the setting of posterior scleritis. The posterior pole has an abnormal appearance and there is macular edema

Figure 2

B-scan ultrasound

Thickening of the choroid and posterior scleral wall (yellow arrow) and fluid in tenon’s capsule (white arrow).

Figure 3 Figure 4

Fluorescein Angiogram

This image taken at 3 minutes and 18 seconds after intravenous injection of fluorescein demonstrates leakage of dye at the optic nerve and macula

Figure 5

Optical Coherence Tomography

OCT imaging of the macula demonstrates cystoid macular edema consistent with the leakage of dye that was noted in the fluorescein angiogram (arrow)

Figure 6

Orbital MRI (Post contrast T1 with fat suppression)

Diffuse enhancement in the right orbit, involving the fat, perineural sheath and extraocular muscles (arrow) suggesting a diffuse orbital and scleral inflammatory process. The left orbit

is normal.

Axial view Coronal view Figure 7 Figure 8

Pathology

Orbital fat biopsy demonstrates chronic non-specific inflammation.

Image courtesy of Dr. Hans Grossniklaus. LF Mongomery Pathology Lab, Emory University

Figure 9

Final Diagnosis

An orbital fat biopsy (anterior approach) showed non-specific inflammation consistent with “idiopathic orbital inflammation” or “orbital pseudotumor”.