Chief & Presenting Author: Dr.Utkarsh Roodkee

Co Author(s): Dr.Vipin Rana, Dr. Sandepan Bandopadhyay, Dr.(Maj) Bharath Mandha

Abstract

Posterior scleritis, often eludes diagnosis due to its diverse clinical presentation. It involves painful inflammation of the sclera behind the ora serrata. 10% of scleritis cases are posterior, with half associated with systemic diseases like rheumatoid arthritis, lupus, and granulomatous polyangiitis. A comprehensive systemic evaluation is crucial. We present the case of a 10-yr-old girl with a painful right eye swelling, accompanied by symptoms such as nausea, vomiting & low-grade fever. VA remains normal, clinical signs include eyelid edema, chemosis, photophobia, no RAPD & disc edema. Systemic investigations reveal elevated ESR and CRP. Brain and orbital MRI indicate possible orbital cellulitis or idiopathic orbital inflammation in the right eye. Initial treatment with IV antibiotics proves ineffective, & oral steroids offer temporary relief but result in symptom recurrence upon tapering. Given the need for prolonged immunosuppression, she's initiated on oral Methotrexate.