EDI-OCT detection of sub-Tenon's fluid in posterior scleritis in myopic eyes: a retrospective case series.

PURPOSE: Posterior scleritis is an uncommon and difficult to diagnose vision-threatening inflammatory condition, particularly in myopic eyes. This study describes enhanced depth imaging optical coherence tomography (EDI-OCT) features of posterior scleritis in myopic eyes and evaluates the diagnostic value of sub-Tenon's fluid on EDI-OCT.

METHODS

Retrospective single-centre case series at tertiary eye unit, Moorfields Eye Hospital, UK. Ten myopic eyes of nine patients (spherical refractive error ≤ - 1.00D) diagnosed with posterior scleritis between January 2018 and December 2024 included. Demographics, best-corrected visual acuity (BCVA), clinical features, treatment, and outcomes were recorded. Macular EDI-OCT scans were reviewed for inflammatory changes, including sub-Tenon's fluid, and compared with ultrasound B-scan findings.

RESULTS

Mean age at presentation was 55 years (range 24-70), 56% female patients and mean refractive error - 4.45D. Mean presenting BCVA was 6/12, improving to 6/9 after treatment (p = 0.009). Presenting symptoms included ocular pain (80% eyes), blurred vision (50%), optic disc swelling sign (40%). All eyes received systemic corticosteroids and 50% required second-line immunosuppression. EDI-OCT demonstrated sub-Tenon's fluid in 60%, subretinal fluid in 30%, cystoid macular oedema in 20%, and choroidal folds in 40%. Sub-Tenon's fluid correlated with the ultrasound T-sign (κ = 0.78; 95% CI 0.39-1.00; p = 0.011; 90% agreement). EDI-OCT abnormalities resolved in 80% of eyes at three months. Mean sub-foveal choroidal thickness was 307 μm and was not correlated with refractive error.

CONCLUSIONS

Sub-Tenon's fluid on EDI-OCT may represent a useful biomarker for posterior scleritis in myopic eyes and a non-invasive adjunct for diagnosis and monitoring.