Bilateral posterior scleritis due to giant cell arteritis

A woman aged mid 70s with mild learning difficulty presented with eye symptoms, headache and shoulder pains. She was found to have bilateral posterior scleritis secondary to giant cell arteritis. Posterior scleritis is a potentially blinding condition, with ambiguous symptoms and signs, therefore di...

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Bibliographic Details
Published in:BMJ case reports 2022-11, Vol.15 (11), p.e251208
Main Authors: Karimi, Ayesha, Wong, Tsz Lun Ernest, Negretti, Guy
Format: Article
Language:English
Subjects:
Case reports
Case Reports: Reminder of important clinical lesson
Edema
Enzymes
Eye Pain
Female
Giant Cell Arteritis - complications
Giant Cell Arteritis - diagnosis
Glaucoma, Angle-Closure - diagnosis
Headaches
Humans
Learning disabilities
Ophthalmology
Pain
Patients
Proteins
Retinal detachment
Rheumatoid arthritis
Rheumatology
Scleritis - diagnosis
Scleritis - drug therapy
Scleritis - etiology
Syphilis
Systemic diseases
Tuberculosis
Ultrasonic imaging
Vein & artery diseases
Vision Disorders - complications
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Description
Summary:A woman aged mid 70s with mild learning difficulty presented with eye symptoms, headache and shoulder pains. She was found to have bilateral posterior scleritis secondary to giant cell arteritis. Posterior scleritis is a potentially blinding condition, with ambiguous symptoms and signs, therefore diagnosis is commonly delayed. This patient was seen in General Practice as well as in Accident and Emergency, where diagnoses of acute angle closure glaucoma as well as iritis were rightfully considered. Her symptoms persisted for 11 days before ophthalmic opinion was sought. Thorough assessment of a painful red eye as well as knowledge of these red-flag signs may allow early treatment and a better outcome for patients. The Royal College of Ophthalmologists has published guidance on how to assess and manage visual loss in people with learning difficulties, including recognising 'symptoms' such as hesitancy on steps, eye rubbing and loss of interest in activities.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2022-251208