Bilateral Idiopathic Posterior Scleritis: A Case Report

Background: A case of bilateral idiopathic posterior scleritis in a patient who developed headache, hypermetropic refractive shift, and bilateral choroidal folds, supported by multimodal ophthalmic imaging. A 52-year-old woman presented with a two-week history of headache and difficulty reading, and was found to have bilateral choroidal folds. She had initially been treated for sinusitis by her general practitioner with oral antibiotics, but did not improve and was referred to our ophthalmology outpatient department. Bilateral posterior scleritis was diagnosed based on B-scan ultrasonography, optical coherence tomography (OCT), and fluorescein angiography findings. An idiopathic aetiology was confirmed after a negative systemic workup. Oral prednisolone resulted in complete resolution of the choroidal folds and full reversal of the hypermetropic shift, with best-corrected visual acuity (BCVA) maintained at 20/20. Conclusion: Bilateral posterior scleritis is uncommon and easily misdiagnosed. A combination of B-scan ultrasonography, OCT, and fluorescein angiography confirmed the diagnosis in this case, and oral prednisolone produced a complete response.