Misdiagnosed Cases of Posterior Scleritis: A Case Series and Review of Literature.

PURPOSE: To report a case series of posterior scleritis referred with an initial misdiagnosis to a tertiary eye care center and to review the literature on misdiagnosed cases of posterior scleritis.

METHODS

Retrospective chart review of patients diagnosed with posterior scleritis, along with a systematic review of published reports on misdiagnosed cases.

RESULTS

Between January 2013 and June 2023, 48 cases of posterior scleritis were evaluated, of which 27 patients (30 eyes; 56.2%) had been initially misdiagnosed elsewhere. The mean age was 44.6 ± 17.5 years (range, 11-73 years), with a female predominance (66.6%). Common initial misdiagnoses included choroidal or retinochoroidal mass lesions and optic neuritis (18.5% each), followed by orbital cellulitis (14.8%), Vogt-Koyanagi-Harada disease and posterior uveitis (11.1% each). Rare misdiagnoses included conjunctivitis, sarcoid panuveitis, anterior uveitis, and hemicranial headache. Ocular pain (70.3%), reduced vision (74.1%), and redness (44.4%) were common presenting features, while 25.9% had no visual complaints. Anterior uveitis was noted in 22.2% and vitritis in 14.8%. Fundus findings included subretinal fluid (56.6%), optic disc edema (36.6%), choroidal folds (26.6%), and mass-like lesions (16.6%). B-scan ultrasonography was performed in only 33.3% of cases, with none demonstrating a T-sign. A literature review identified previously reported misdiagnosed cases, which were analyzed and tabulated with their clinical features and reasons for misdiagnosis.

CONCLUSION

Posterior scleritis is frequently overlooked due to its protean and heterogeneous clinical presentations, leading to misdiagnosis as other ocular or orbital conditions.