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Anterior and Posterior Scleritis. Joshua Levinson, MD Valerie Biousse , MD. External Photograph. Figure 1. Note the injection of scleral and episcleral vessels with edema of the scleral wall. Fundus Photograph. Figure 2. - PowerPoint PPT Presentation
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Anterior and Posterior Scleritis
Joshua Levinson, MD Valerie Biousse, MD
External Photograph
Note the injection of scleral and episcleral vessels with edema of the scleral wall
Figure 1
Fundus Photograph
Unilateral optic disk edema in the setting of posterior scleritis. The posterior pole has an abnormal appearance and there is macular edema
Figure 2
B-scan ultrasound
Thickening of the choroid and posterior scleral wall (yellow arrow) and fluid in tenon’s capsule (white arrow).
Figure 3 Figure 4
Fluorescein Angiogram
This image taken at 3 minutes and 18 seconds after intravenous injection of fluorescein demonstrates leakage of dye at the optic nerve and macula
Figure 5
Optical Coherence Tomography
OCT imaging of the macula demonstrates cystoid macular edema consistent with the leakage of dye that was noted in the fluorescein angiogram (arrow)
Figure 6
Orbital MRI (Post contrast T1 with fat suppression)
Diffuse enhancement in the right orbit, involving the fat, perineural sheath and extraocular muscles (arrow) suggesting a diffuse orbital and scleral inflammatory process. The left orbit
is normal.
Axial view Coronal view Figure 7 Figure 8
Pathology
Orbital fat biopsy demonstrates chronic non-specific inflammation.
Image courtesy of Dr. Hans Grossniklaus. LF Mongomery Pathology Lab, Emory University
Figure 9
Final Diagnosis
An orbital fat biopsy (anterior approach) showed non-specific inflammation consistent with “idiopathic orbital inflammation” or “orbital pseudotumor”.