A 51-year-old woman, with no relevant personal history, was referred to the Uveitis Unit of our center due to episodes of ocular pain and progressive decrease of visual acuity in both eyes of 3 years of partially steroid evolution.
The examination showed a best corrected visual acuity (BCVA) of 0.7 in right eye (OD) and 0.5 in left eye (LE).
Intraocular pressure was 28 and 19mmHg, respectively.
Biomicroscopy of the anterior segment in the RE showed a slight redness of the temporal sector.
The fundus of the eye presented hemorrhage in the inferior peripapillary, superior temporal choroidal folds and lipid exudates, with the retina applied.
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The image obtained with B-mode ultrasound showed diffuse sclerotic thickening along with fluid in the adjacent Tenon capsule, giving rise to the «T» sign.
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An interconsultation to Internal Medicine was made, carrying out an exploration by apparatus and systems, and biochemical and blood markers were also requested (SGA, CRP, ANA, ANCA, RF, B27, infectious serology).
A nuclear magnetic resonance (MR) and a computerized axial tomography were also requested to rule out another type of ocular or orbital lesion.
In view of the results, the patient was diagnosed with idiopathic posterior scleritis and ocular hypertension secondary to the pharmacological treatment corticoid, and started again treatment with oral prednisone together with ocular antihypertensives.
Quarterly controls are carried out, among which the patient suffers recurrent episodes of ocular pain and redness of both eyes, being the fundus and subtle signs only on ultrasound (scleral thickening).
In order to assess the inflammatory activity in these doubtful situations, we used OCT anomalies, and in case the patient achieved the presence of folds at the level of the internal retina/EPR/coriocapilar OCT as indirect signs of inflammation.
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Given the chronicity of the process and the need to require long-term corticosteroid treatment, maintenance therapy with methotrexate, with corticosteroid rescue.
Currently, the patient is stable, with no evidence of inflammation in the examination or ultrasound examination.
