Posterior scleritis in children: clinical features and treatment

Objective: To summarize the clinical findings and treatment response in posterior scleritis affecting children and to compare these features with posterior scleritis affecting adults.

Design: Retrospective interventional case series.

Participants: Twenty eyes of 13 patients aged younger than 18 years who were diagnosed with posterior scleritis in a tertiary referral center.

Intervention: Investigations and treatment were according to standard care, following published recommendations for scleritis.

Main outcome measures: Clinical features, investigation results, treatment received, and visual outcome were studied.

Results: Twenty eyes of 13 patients (aged 5-16 years, median 11.53 years; 8 female, 5 male) were included. Scleritis was unilateral in 6 cases and bilateral in 7 cases at presentation. The median presenting vision was 20/30. All eyes had T-sign demonstrable on B-scan ultrasound. Concurrent anterior segment signs included anterior uveitis (80.0%) and anterior scleritis (20.0%). Posterior segment signs included optic disc swelling (95.0%) and retinal striae (85.0%). No underlying connective tissue disorder was diagnosed in any patient. Scleritis resolved with oral nonsteroidal anti-inflammatory agent alone in 1 patient (8%). Twelve patients (92.3%) received oral corticosteroid. Immunosuppressive agents were required in 11 patients (84.6%) because of relapse or intolerance to corticosteroid. The median final vision at 1 year was 20/20. Seven patients (63.6%) remained on immunosuppression at latest follow-up (median 4 years).

Conclusions: Common features of posterior scleritis include concurrent anterior uveitis, disc swelling, and retinal striae. B-scan ultrasound demonstrating T-sign was the most useful confirmatory investigation in all cases. Systemic association is uncommon. Aggressive therapy with systemic corticosteroid achieves resolution mostly within the first year. Long-term immunosuppression is often required to prevent recurrence. Visual outcome is favorable.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.