This report aimed to facilitate the correct diagnosis of posterior scleritis, a condition which is usually overlooked or misdiagnosed. Electronic health records of 31 patients with posterior scleritis were analysed and compared to a group with isolated anterior scleritis of any kind. Eighty-four percent of patients with posterior scleritis were female. The mean age of presentation was 44 years. Pain was present in all patients, with most having subacute and unilateral inflammation. Decrease in vision (20/80 or worse at presentation and / or loss of two or more Snellen lines) was documented in 29% of patients with posterior scleritis. Sixty-eight percent had associated anterior scleritis and 26% anterior uveitis at some point during follow-up. Eighty-one percent of cases were idiopathic while psoriatic arthritis, Crohn’s disease, HLA-B27, SLE and TINU were the other associated systemic conditions. Uveitis was more frequently associated in patients younger than 40 years. The mean age of patients with posterior scleritis was lower than those with anterior scleritis. Association with a systemic disease was found more frequently in patients with isolated anterior scleritis than in those with posterior scleritis. The authors comment that visual loss is more frequent than in those with anterior scleritis. They therefore recommend that all scleritis patients should undergo B-Scan ultrasonography so as not to miss any posterior disease. Although not statistically significant, they found that the more painful eyes had a greater chance of a decrease in vision.

Clinical features and presentation of posterior scleritis: a report of 31 cases.
Gonzalez-Gonzalez LA, Molina-Prat N, Doctor P, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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