17.6

Posterior Scleritis

Introduction:

Posterior scleritis is uncommon inflammation of the sclera occurring posterior to the insertion of the rectus muscles. Posterior scleritis can occur in isolation or in association with anterior scleritis. There is strong female preponderance due it is association with autoimmune disorders. Scleritis has been associated with many systemic diseases, but the strongest association is with rheumatoid arthritis. It usually occurs in the fourth to sixth decades of life. Infectious scleritis has also been reported, but infectious posterior scleritis is rare.

Clinical Features:

Common presenting features are pain, tenderness, blurred vision, proptosis and pain or restriction of eye movements. One-third of patients will have no pain. Common findings include retinal striae, exudative retinal detachment and choroidal thickening and detachments (Fig. 17.6.1). Less common manifestations are macular and disc edema, subretinal mass, hemorrhages and exudation. Diagnosis may be difficult in the absence of anterior scleritis.

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