Anterior scleritis following intravitreal injections in a patient with rheumatoid arthritis: A case report

Abstract

Rationale: Surgically induced scleritis is a rare complication following ophthalmologic surgery such as cataract surgery, pterygium excision, strabismus surgery, and retinal detachment repair. Rheumatoid arthritis (RA) is the connective tissue disease most commonly associated with scleritis.

Patient concerns: A 70-year-old woman visited our clinic with complaint of visual disturbance, ocular pain, and conjunctival injection in her right eye of 1 month's duration. She had a stable state of rheumatoid factor positive RA and had a history of multiple intravitreal injections placed in the symptomatic right eye due to age-related macular degeneration.

Diagnoses: Anterior scleritis induced by multiple intravitreal injections.

Interventions: Topical and systemic steroids were administered.

Outcomes: Her symptoms and signs were relieved and no significant recurrence has been occurred with the maintenance of low dose oral steroid.

Lessons: Surgically induced scleritis can also be induced by not only major surgical trauma but also by relatively minor trauma such as intravitreal injection (especially in patients who have connective tissue disease such as RA).

Figure 1

Exudation was observed on fundus photography (A) and active macular choroidal neovascularization and subretinal fluid were observed on optical coherence tomography (B). Following intravitreal injection, subretinal fluid was markedly decreased on optical coherence tomography (C), but anterior diffuse scleritis occurred (D, E).

Figure 2

Anterior segment photos (A) show marked injection (asterisk) around the intravitreal injection site in the right eye. The patient complained of tenderness to palpation, and photophobia. There was scleral edema and dilatation of the deep episcleral vascular plexus on slit lamp examination and no signs of corneal infiltrates, thinning, and ulceration. Anterior segment photos (B) show decreased scleral edema and dilatation of the deep episcleral plexus after treatment for anterior diffuse scleritis, compared with the previous signs on the left. The subjective symptoms such as ocular pain and photophobia in her right eye resolved, as well.