Título

POSTERIOR SCLERITIS

Objetivo

Posterior scleritis is the inflamatorious process of the sclera. It is considered a rare disease, associated with systemic diseases in 50-70% of all patients. We describe a case with recurrent complains of pain and redness in eyes for 8 years, without a definitive diagnosis.

Relato do Caso

Female patient, 32 years old, complaining about pain in her right eye, started 7 days before, progressive, associated with conjunctival redness and impairment of visual acuity. She already attended at Neurology since 2008, to investigate similar episodes, always unilateral but affecting both eyes, with annual recurrences. She referred improvement of pain after using imunossupressors, and neurology was investigating same possible central nervous system cause. Ophthalmologic: visual acuity 20/20 in both eyes. Photomotic reflections present and symmetrical bilaterally. Biomicroscopy: conjunctival redness 2/4+, intraocular pressure 12mmHg in both eyes. Fundoscopy showed choroidal folds in both eyes. Ultrasonography revealed scleral thickening and sub-tenonian liquid, characterizing the T-Sign. In laboratory exams, erythrocyte sedimentation rate of 14 mm (normal:10 mm), C-reactive protein of 0.14 mg/dl. She underwent for 3 days of Methylprednisolone use, with improvement of her ocular complaints after 2 days.

Conclusão

Scleritis can be classified based on its location and type of inflammatory process. Posterior scleritis can cause rapid and progressive visual impairment. It usually affects middle-age women. The most frequent symptoms are: ocular pain, intense and continuous, which can be worst by night. Headache, conjunctival redness and visual impairment can be associated. The signs are: retinal detachment, choroidal folds, sub retinal mass, disc edema, myositis, proptosis, corneal alterations, angle-closure glaucoma secondary to thickening of the choroid, uveitis and cataract. Diagnosing this condition can be difficult, and a rigorous evaluation must be done. Treatment consists in non-hormonal anti-inflammatories, steroids and immunosuppressive therapy.