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Anterior and Posterior Scleritis. Joshua Levinson, MD Valerie Biousse , MD. External Photograph. Figure 1. Note the injection of scleral and episcleral vessels with edema of the scleral wall. Fundus Photograph. Figure 2.
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Anterior and Posterior Scleritis Joshua Levinson, MD Valerie Biousse, MD
External Photograph Figure 1 Note the injection of scleral and episcleral vessels with edema of the scleral wall
Fundus Photograph Figure 2 Unilateral optic disk edema in the setting of posterior scleritis. The posterior pole has an abnormal appearance and there is macular edema
B-scan ultrasound Figure 3 Figure 4 Thickening of the choroid and posterior scleral wall (yellow arrow) and fluid in tenon’s capsule (white arrow).
Fluorescein Angiogram Figure 5 This image taken at 3 minutes and 18 seconds after intravenous injection of fluorescein demonstrates leakage of dye at the optic nerve and macula
Optical Coherence Tomography Figure 6 OCT imaging of the macula demonstrates cystoid macular edema consistent with the leakage of dye that was noted in the fluorescein angiogram (arrow)
Orbital MRI(Post contrast T1 with fat suppression) Axial view Coronal view Figure 7 Figure 8 Diffuse enhancement in the right orbit, involving the fat, perineural sheath and extraocularmuscles (arrow) suggesting a diffuse orbital and scleral inflammatory process. The left orbit is normal.
Pathology Figure 9 Orbital fat biopsy demonstrates chronic non-specific inflammation. Image courtesy of Dr. Hans Grossniklaus. LF Mongomery Pathology Lab, Emory University
Final Diagnosis An orbital fat biopsy (anterior approach) showed non-specific inflammation consistent with “idiopathic orbital inflammation” or “orbital pseudotumor”.
