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Paediatric Ophthalmology

Case 8


Patient Presentation: An 11-year-old boy was referred to a pediatric ophthalmology clinic for two days of blurred vision OS. His mother noted that he was recently diagnosed with a sinus infection due to a few weeks of facial pressure and periorbital pain. He was treated with nasal decongestants, but his symptoms did not improve. The patient denied red eye, photophobia, flashes, floaters or a visual field deficit. He had no past medical or ocular history.

On examination, BCVA was 20/20 OD and 20/70 OS. There was no RAPD and IOP was within normal limits. Extraocular motility was full, but he did note pain OS on abduction and elevation. There was no exophthalmos. Anterior segment examination was within normal limits.

Bilateral fundus photographs were taken and are shown below:


OCT macula images were taken and are shown below:


Question 1: What is the main finding in the OCT macula image above?

Question 2: What is the next imaging modality you would order?

Question 3: Based on the patient presentation, fundus photography, OCT imaging and B-Scan ultrasonography imaging, what is the most likely diagnosis?

Question 4: What is the first-line treatment for patients with this disease process?

One month following initiation of PO Prednisone treatment, the patient was seen in follow-up. His BCVA was 20/20 OD and 20/20 OS. OCT images (shown below) demonstrate resolution of his subretinal fluid and reduced choroidal thickening. His work-up was negative; therefore, he was diagnosed with idiopathic posterior scleritis and is undergoing regular monitoring by Ophthalmology.



  1. Lavric A, Gonzalez-Lopez JJ, Majumber PD, et al. Posterior scleritis: Analysis of epidemiology, clinical factors, and risk of recurrence in a cohort of 114 patients. Ocul Immunol Inflamm 2016;24(1):6-15.

  2. McCluskey PJ, Watson PG, Lightman S, Haybittle J, Restori M, Branley M. Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients. Ophthalmology 1999;106(12):2380-6. 


Learning Objectives:

  1. Understand the classic OCT and multimodal imaging signs of posterior scleritis

  2. Learn the work-up and treatment for posterior scleritis

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