Nodular Posterior Scleritis Masquerading as a Subretinal Mass

Abstract

This is the case report of a 50-year-old female with no systemic comorbidities who presented to the eye clinic with a 1-month history of right-sided eye pain and visual loss. Examination revealed no signs of inflammation in the right eye, with no proptosis or conjunctival injection. A relative afferent pupillary defect was present with no inflammatory cells in the vitreous. On fundoscopy, there was a swollen disc, a large superior creamy white subretinal mass associated with a shallow overlying retinal detachment. B-scan ultrasonography confirmed the presence of a subretinal mass. Hematological investigations revealed an elevated erythrocyte sedimentation rate. Infective and autoimmune markers were negative. A diagnosis was made of nodular posterior scleritis and the patient was treated with intravenous corticosteroids initially, and subsequently switched to oral corticosteroids. There was complete resolution of the mass with optic atrophy as a result. Posterior nodular scleritis is an extremely rare potentially vision-threatening ocular condition that requires multimodal investigations to diagnose and treat appropriately.

Keywords: Nodular scleritis; posterior scleritis; subretinal mass.

Figure 1

(a and b) Fundus pictures of subretinal mass on admission. (c) After 3 days of intravenous steroid treatment. (d) After 1 month of steroid treatment (initially intravenous and subsequently oral treatment)

Figure 2

B-scan ultrasonography showing the hyperechoic subretinal mass

Figure 3

Macula optical coherence tomography of the right eye pre-treatment with systemic steroids

Figure 4

Macula optical coherence tomography of the right eye post-treatment with systemic steroids