Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3779-3786
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3779
Bilateral posterior scleritis presenting as acute primary angle closure: A case report
Chao Wen, Hui Duan
Chao Wen, Department of Anesthesia, The First Affiliated Hospital of Dalian Medical University, Dalian 116001, Liaoning Province, China
Hui Duan, Department of Ophthalmology, The First Affiliated Hospital of Dalian Medical University, Dalian 116001, Liaoning Province, China
Author contributions: Wen C wrote and revised the paper; Duan H was the patient's ophthalmologist, reviewed the literature, and contributed to drafting of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Duan, MD, Associate Professor, Department of Ophthalmology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116001, Liaoning Province, China. duanhui927@outlook.com
Received: January 10, 2021
Peer-review started: January 10, 2021
First decision: February 12, 2021
Revised: February 16, 2021
Accepted: March 4, 2021
Article in press: March 4, 2021
Published online: May 26, 2021
Processing time: 121 Days and 8.1 Hours
Abstract
BACKGROUND

Scleritis is a rare disease and the incidence of bilateral posterior scleritis is even rarer. Unfortunately, misdiagnosis of the latter is common due to its insidious onset, atypical symptoms, and varied manifestations. We report here a case of bilateral posterior scleritis that presented with acute eye pain and intraocular hypertension, and was initially misdiagnosed as acute primary angle closure. Expanding the literature on such cases will not only increase physicians’ awareness but also help to improve accurate diagnosis.

CASE SUMMARY

A 53-year-old man was referred to our hospital to address a 4-d history of bilateral acute eye pain, headache, and loss of vision, after initial presentation to a local hospital 3 d prior. Our initial examination revealed bilateral cornea edema accompanied by a shallow anterior chamber and visual acuity reduction, with left-eye amblyopia (> 30 years). There was bilateral hypertension (by intraocular pressure: 28 mmHg in right, 34 mmHg in left) and normal fundi. Accordingly, acute primary angle closure was diagnosed. Miotics and ocular hypotensive drugs were prescribed, but the symptoms continued to worsen over the 3-d treatment course. Further imaging examinations (i.e., anterior segment photography and ultrasonography) indicated a diagnosis of bilateral posterior scleritis. Methylprednisolone, topical atropine, and steroid eye drops were prescribed along with intraocular pressure-lowering agents. Subsequent optical coherence tomography (OCT) showed gradual improvements in subretinal fluid under the sensory retina, thickened sclera, and ciliary body detachment.

CONCLUSION

Bilateral posterior scleritis can lead to secondary acute angle closure. Diagnosis requires ophthalmic accessory examinations (i.e., ultrasound biomicroscopy, B-scan, and OCT).

Keywords: Acute primary angle closure; Posterior scleritis; Differential diagnosis; B-scan; Optical coherence tomography; Case report

Core Tip: Bilateral scleritis is the rarest form of scleritis. The clinical presentation is quite variable, which can make diagnosis even more difficult. Among all cases of scleritis, the overall frequency of intraocular hypertension is low, at only 12.6%. Moreover, among that subpopulation of scleritis cases, bilateral involvement with shallow anterior chamber is often misdiagnosed as uveitis (especially, Vogt-Koyanagi-Harada syndrome) and acute primary angle-closure glaucoma. Differential diagnosis is essential for accurate and effective treatment. We report here a case of bilateral posterior scleritis with acute eye pain and intraocular hypertension, initially misdiagnosed as acute primary angel closure.