Purpose

To describe a case of acute angle closure attack complicating unilateral anterior and posterior scleritis

Methods

single case report

Results

A 29-year-old woman with no past medical history, presented to our department with a red and painful right eye (OD) for the past three days. BCVA was limited to 1/20 in OD with diffuse conjunctival hyperemia and scleral vessel dilation. The neosynephrine test was negative. Anterior segment examination showed a narrow anterior chamber, intraocular pressure was 34 mmHg with a closed iridocorneal angle on gonioscopy. Funduscopy demonstrated the presence of posterior chorioretinal folds. Examination of the left eye was unremarkable. Ultrasound biomicroscopy revealed OD total circumferential closure of the iridocorneal angle with a thickened and hypervascularized choroid. She underwent an exhaustive workup that came back normal. The patient was treated with topical cycloplegics associated to systemic corticosteroids with complete recovery. During follow-up she had several OD recurrences that required immunosuppressive therapy. Six months later, she remains clinically improved without recurrences.

Conclusions

Acute angle-closure attack secondary to ciliochoroidal effusion rarely complicates posterior scleritis. The management is based on corticosteroids therapy with rapidly and complete disappearance of the lens–iris diaphragm posterior displacement. In our case, treatment with immunosuppressive drugs was indicated in the presence of recurrences despite a negative etiological assessment.