Uveitis

Case 2

Contributors: Dr. Hatim Batawi and Dr. Kamiar Mireskandari

Patient Presentation: A healthy 10 year old girl presented with 2 month history of recurrent bilateral eye redness, dull aching eye pain with movement, and severe frontal headaches. The headache was usually worse at night and sometimes woke her up from sleep. Review of system was remarkable for low grade fever. Her past ocular and medical history were unremarkable. On exam, her vision was 20/20 OD and 20/25 OS. There was no RAPD OU. IOP was 15 OD and 14 OS. EOM was intact OU. Slit lamp exam showed slight conjunctival injection and 2+ cells in A/C OU.  The fundus photo of both eyes are shown below:

Question: What are the most notable abnormalities in the fundus photograph?

Question: The macular OCT images of both eyes are shown above. What are the most notable abnormalities in the OCT images?

Question: The B-scan image of the left eye is shown above.  What are the abnormalities in the B-scan image?

Question: What is the likely diagnosis?

Question: What are the OCT imaging features that might be found in posterior scleritis during the active phase?

References:

1. Cheung CM, Chee SP. Posterior scleritis in children: clinical features and treatment. Ophthalmology. 2012;119(1):59-65. doi:10.1016/j.ophtha.2011.09.030

2. Ge WANG, Xiaoyan Peng; The Imaging features of SS-OCT in Posterior Scleritis and Its Application to Clinic. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3229.

3. Mallick J, Pujahari S, Maharana PK Posterior scleritis presenting as conjunctivitis in a child. Case Reports. 2016;2016:bcr2016217968.

Learning Objectives:

1. Identify the OCT features associated with posterior scleritis

2. Identify the B-scan features associated with posterior scleritis

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