A 51-year-old woman, with no personal history of interest, was referred to the Uveitis Unit of our centre due to episodes of ocular pain and progressive decrease in visual acuity in both eyes over a 3-year period, which had partially subsided with corticoids.
On examination she had a best corrected visual acuity (BCVA) of 0.7 in the right eye (OD) and 0.5 in the left eye (OI). Intraocular pressure was 28 and 19mmHg, respectively. Biomicroscopy of the anterior segment in the OD showed a slight reddening of the temporal sector.
The right fundus showed haemorrhage in the inferior peripapillary splinter, superior temporal retinochoroidal folds and lipid exudates, with the retina applied.

The B-mode ultrasound image showed diffuse scleral thickening together with fluid in the adjacent Tenon's capsule giving rise to the "T" sign.

A referral to Internal Medicine was made, which carried out an examination by apparatus and systems, and also requested biochemical and blood markers (ESR, CRP, ANA, ANCA, RF, B27, infectious serology), which ruled out the presence of associated systemic disease. Magnetic resonance imaging (MRI) and computed axial tomography (CT) were also requested, which ruled out other types of ocular or orbital lesions.
In view of the results, the patient was diagnosed with idiopathic posterior scleritis and ocular hypertension secondary to corticosteroid drug treatment, and treatment with oral prednisone and ocular antihypertensives was started again.
Quarterly check-ups were carried out, between which the patient suffered recurrent episodes of ocular pain and redness in both eyes, with only subtle signs being evident both in the ultrasound (slight sclerochoroidal thickening) and in the ocular fundus. In order to assess inflammatory activity in these doubtful situations, we used OCT, which revealed the presence of folds in the inner retina/EPR/choriocapillaris as indirect signs of scleral inflammation, so that OCT allowed adequate monitoring of the patient until a stable clinical situation was achieved, manifested in this case by the absence of tomographic abnormalities.

Given the chronicity of the process and the need for prolonged corticosteroid treatment, maintenance treatment with methotrexate was introduced, with corticosteroid rescue.
The patient is currently stable, with no signs of inflammation in the ophthalmological examination or in the tomographic or ultrasound tests.

