Clinical and tomographic characteristics of anterior scleritis

AbstractPurpose: To describe clinical, etiological and tomographic features of anterior scleritis.Methods: Retrospective case series study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between the 1st January 2021 and the 1st January 2022. Nine patients (12 eyes) with anterior scleritis were included. All patients underwent complete ophthalmic examination including anterior segment and fundus slit lamp examination. The cases were documented with multimodal imaging including anterior segment optical coherence tomography (AS‐OCT). All patients were referred to the internal medicine department for general examination.Results: The median age of the patients was 37 years. 44% were male and 56% were female. Ophthalmic examination revealed diffuse conjunctival hyperemia and scleral vessel dilation with negative neosynephrine test in all eyes. The scleritis was bilateral in 3 patients, diffuse in 6 eyes, nodular in 5 eyes and necrotizing in 1 eye. One eye was complicated with angle closure glaucoma, 2 eyes had anterior uveitis, 1 eye had retinal vasculitis and 2 eyes were associated with posterior scleritis. AS‐OCT revealed a narrow anterior chamber and a closed angle in 1 eye, dilated scleral vessels in all eyes, thickening of the sclera in 11 eyes, dome‐shaped hyperreflective lesions corresponding to the nodules in 5 eyes and thinning of the sclera in the eye with necrotizing scleritis. Systemic disease was found in 7 patients. Main etiologies were tuberculosis in 3 patients and Behçet disease in 2 patients. The other two diagnosis were granulomatosis with polyangiitis and MacDuffie syndrome.Conclusion: In our case series Behcet disease and tuberculosis were the main diagnosis of anterior scleritis. AS‐OCT could show different features of anterior scleritis depending on the clinical presentation and could consequently help to monitor the inflammation.