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Figures
- Fig 1.
Asynchronous IOID with scleritis. A, CECT depicts outward, eccentric thickening and enhancement of the right globe wall with focal periscleral cellulitis (black arrow), compatible with posterior scleritis. There is associated pre- and postseptal cellulitis (white arrow) and proptosis. B, CECT 18 months after examination (A) shows almost identical findings in the left orbit. Black and white arrows point to the scleritis and cellulitis, respectively. Notice the complete resolution of the alterations of the right orbit. Also, notice involvement of the tendon of the lateral rectus anteriorly (dashed arrow).
- Fig 2.
Bilateral inflammatory isolated scleritis: axial MR images. A, Post-Gd-DTPA T1-weighted image with fat saturation shows bilateral enhancement of the outer aspect of the sclera (white arrows) extending to the optic nerve sheath, depicting scleritis. There is also focal periscleral cellulitis. Notice the absence of ocular anomalies on the precontrast T1WI (B).
- Fig 3.
Nodular inflammatory scleritis mimicking uveal melanoma. CECT depicts a posterior globe wall mass (black arrow) deviating the choroid-retinal layer internally (white arrow), and hence, most probably arising from the sclera. Also notice the presence of slight periscleral cellulitis.
- Fig 4.
Infectious orbital process with scleritis followed by panophthalmitis. Post-Gd-DTPA axial T1-weighted spectral presaturation with inversion recovery image of the orbit (A) depicts scleral enhancement (black arrow) and extensive pre- and postseptal cellulitis, with involvement of the optic nerve sheath (white arrow) and dacryoadenitis (asterisk). CECT performed 48 hours later (B) shows lens luxation (white arrow) and inward folding of the globe wall with volume loss (black arrow), depicting globe rupture.
- Fig 5.
Orbital inflammation with scleritis in patient with granulomatosis with polyangiitis (Wegener). T1WI (A) shows eccentric focal thickening of the sclera (black arrow), with coexisting enlargement of the lacrimal gland (white arrow), both enhancing on the post-Gd-DTPA T1-weighted spectral presaturation with inversion recovery image (B). Enhancement extends to the optic nerve sheath (open arrow heads). This illustrates posterior scleritis with optic perineuritis, cellulitis, and dacryoadenitis.
- Fig 6.
Scleritis with vitritis and uveitis. Enhanced coronal (A) and axial (B) T1-weighted spectral presaturation with inversion recovery images and axial T2WI (C) with a sclerouveitis. There is increased signal intensity of the vitreous on the left (vitritis; A, B, asterisk), with slight focal enhancement of the iris/cilliary body (uveitis; white arrow) and concurrent slight focal scleral outward thickening (C, black dashed arrow) and enhancement (B, black solid arrow).
- Fig 7.
Isolated inflammatory scleritis: orbital MR imaging. T2-weighted (A) and Gd-DTPA enhanced T1-weighted spectral presaturation with inversion recovery (B) images depict scleral thickening and enhancement (B, white arrow). There is a linear hyperintense (fluid) collection between the sclera and the choroid/retina, representing a suprachoroidal effusion (A, white arrowhead).
Tables
Pt Duration of Symptomsa US Performed, Diagnosis Clinical Diagnosisb Imaging Modality Systemic Disease Final Diagnosis 1 5 mo No Infectious cellulitis CT Down syndrome IOID with scleritis 1 2 mo No Infectious cellulitis CT Down syndrome IOID with scleritis 2 3 mo Yes, disc edema Optic neuritis MRI Not found Bilateral idiopathic scleritis 3 2 mo No Intraorbital mass CT Not found Idiopathic scleritis 4 2 mo Yes, uveal mass Choroidal melanoma CT Not found Nodular idiopathic scleritis 5 Acute No Infectious cellulitis CT, MRI DRM; Colon carcinoma Infectious orbital disease with panophthalmitis 6 6 mo No Infectious cellulitis CT, MRI Down syndrome IOID with sclerouveitis 7 1 mo Yes, scleritis Scleritis or tumor MRI Granulomatosis with polyangiitis Autoimmune orbital inflammation with scleritis 8 2 mo No Uveitis CT, MRI JIA Autoimmune sclerouveitis 9 3 wk Yes, inconclusive Optic pathway condition CT, MRI None Idiopathic scleritis 10 4 wk No Optic pathway condition MRI None Idiopathic scleritis Note:—DRM indicates dermatomyositis; JIA, juvenile idiopathic arthritis; Pt, patient; US, ultrasonography.
↵a Duration of symptoms refers to the time elapsed between onset of symptoms of scleritis (pain, vision disturbances) and the time of imaging.
↵b Diagnosis after ophthalmologic evaluation and ultrasound and before CT and/or MRI.
Imaging Modality Imaging Finding No. (%) CT Eccentric enhancement of the globe wall 8 (100) Eccentric thickening of the sclerouveal rim 8 (100) Periscleral cellulitis 6 (75) Pre/postseptal cellulitis 4 (50) Nodular scleral tickening 1 (13) MR Scleral enhancement 8 (100) Scleral thickening 6 (75) Focal periscleral cellulitis 4 (50) Pre/postseptal cellulitis 2 (25) Scleral thinning 1 (13) Dacryoadenitis 1 (13) Uveitis 2 (25) Suprachoroidal effusion 1 (13) Retinal detachment 1 (13) Choroidal detachment 1 (13)
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