Idiopathic Necrotizing Scleritis, Anterior Uveitis, and Localized Retinal Detachment

Aim: To present clinical picture and treatment of anterior idiopathic necrotizing scleritis.

Methods: Clinical and laboratory examination; B-scan ultrasound; tissue biopsy and histological analysis, were performed.

Results: Herewith we depict a case of 74 year old man, with unilateral granulomatous, anterior, necrotizing scleritis. Etiology has, through extensive testing, both laboratorial and clinical, not been proven and thus the patient has been classified as having idiopathic scleritis. Complications on both anterior (anterior uveitis) and posterior (subretinal granulomatous infiltrates with localized retinal detachment) segments of the eye are a consequence of granulomatous necrotizing scleritis. Both tissue biopsy of granulomatous scleral infiltrates and histological analysis showed that this is the case of granulomatous, partially necrotizing scleritis with some elements of vasculitis. Progression of granulomatous scleral infiltrates into the eye has also been shown through clinical examination and B-scan ultrasound, and depicted subretinal lesion of medium reflectivity that is in contact with the epibulbar lesion. Retinal detachment in this area had progressed and required excessive laser photocoagulation barrage and resulted in absorption of subretinal fluid. Positive therapeutic outcome was achieved through the use Methotrexate and corticosteroids.

Conclusion: Granulomatous infiltrates that spread towards the subretinal space and result in localized retinal detachment are a rare complication that may occur during the evolution of necrotizing scleritis and require regular monitoring and followup. Treatment, both pharmaceutical and laser photocoagulation, should be adjusted in order to affect progression and prevent possible complications of the disease.