Bilateral combined anterior and posterior scleritis – A case of organ-limited idiopathic vasculitis

We present a case of a 69-year-old female with complains of bilateral painful red eyes and blurred vision. The patient was treated elsewhere for allergic conjunctivitis and then came here for a second opinion. The patient was diagnosed as a case of bilateral anterior plus posterior scleritis based on clinical findings, optical coherence tomography (OCT), and ultrasound B-scan reports. Thorough systemic evaluation for the possibility of infection and systemic vasculitis was performed based on a rheumatologist opinion. Topical and systemic steroids along with cyclophosphamide were started after admitting the patient for diabetes monitoring. The patient regained the best corrected vision from 6/12 to 6/6 with complete resolution of OCT findings after 15 days. This case highlights the importance of thorough eye check-up including posterior segment evaluation in all cases of scleritis and a multi-disciplinary approach in order to achieve early remission of the episode.