title: Posterior scleritis in children: clinical features and treatment.
abstract: OBJECTIVE
  To summarize the clinical findings and treatment response in posterior scleritis affecting children and to compare these features with posterior scleritis affecting adults.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Twenty eyes of 13 patients aged younger than 18 years who were diagnosed with posterior scleritis in a tertiary referral center.
  
  
  METHODS
  Investigations and treatment were according to standard care, following published recommendations for scleritis.
  
  
  METHODS
  Clinical features, investigation results, treatment received, and visual outcome were studied.
  
  
  RESULTS
  Twenty eyes of 13 patients (aged 5-16 years, median 11.53 years; 8 female, 5 male) were included. Scleritis was unilateral in 6 cases and bilateral in 7 cases at presentation. The median presenting vision was 20/30. All eyes had T-sign demonstrable on B-scan ultrasound. Concurrent anterior segment signs included anterior uveitis (80.0%) and anterior scleritis (20.0%). Posterior segment signs included optic disc swelling (95.0%) and retinal striae (85.0%). No underlying connective tissue disorder was diagnosed in any patient. Scleritis resolved with oral nonsteroidal anti-inflammatory agent alone in 1 patient (8%). Twelve patients (92.3%) received oral corticosteroid. Immunosuppressive agents were required in 11 patients (84.6%) because of relapse or intolerance to corticosteroid. The median final vision at 1 year was 20/20. Seven patients (63.6%) remained on immunosuppression at latest follow-up (median 4 years).
  
  
  CONCLUSIONS
  Common features of posterior scleritis include concurrent anterior uveitis, disc swelling, and retinal striae. B-scan ultrasound demonstrating T-sign was the most useful confirmatory investigation in all cases. Systemic association is uncommon. Aggressive therapy with systemic corticosteroid achieves resolution mostly within the first year. Long-term immunosuppression is often required to prevent recurrence. Visual outcome is favorable.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.
authors.forename: Chui Ming Gemmy
authors.initials: CM
authors.lastname: Cheung
authors.forename: Soon-Phaik
authors.initials: SP
authors.lastname: Chee
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D058447:Eye Pain / Q000175:diagnosis; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D010211:Papilledema / Q000175:diagnosis; D057972:Posterior Eye Segment / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D015423:Scleritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014463:Ultrasonography; D014786:Vision Disorders / Q000175:diagnosis; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents