POSTERIOR SCLERITIS –A DIAGNOSTIC DILEMMA后巩膜炎–诊断困境.pptVIP

* * * * * * * * * * * * MULTI-NODULAR POSTERIOR SCLERITIS Dr Nilutpal Borah, M.S. Guwahati Eye Institute and Research Center Assam , India 15 year old girl was admitted in a neurology hospital suspecting of intracranial lesion. Referred for eye examination. Ocular history OS – 1 week- sudden , complete, painful loss of vision with swelling. Pain around the left periorbital region, radiating towards left hemicranium, left ear and left side of the neck. Nausea and vomiting . Past history 5 months ago- OS – pain, redness, dimness of vision. Treatment was incomplete. 1 year ago- OD - similar episode of pain redness. No treatment . Clinical findings Tender globe VA -OD 6/6, OS PL negative (max illumination with IDO) OS - RAPD + Lids swollen, mild superior conjunctival and episcleral congestion. flare +, cell+ , fibrinous deposition on crystalline lens Fundus- OD- vitreous cells + OS- vitreous cells ++, Several small and medium, yellowish, sub-retinal mass lesions. Retinal blot hemorrhage, exudative detachment. Disc – hyperaemic edematous Investigations Blood R/E - ESR 40 mm(1st hr) Hb 9.0% Urine R/E - Albumin trace Pus cell 2-4/HPF Epithelial cells 1-2/HPF Investigations Systemic examinations - unremarkable. Paranasal sinuses - normal CT Scan brain - normal X - ray -chest - normal Stool R/E - ova cysts- absent Montoux test - negative VDRL - non-reactive ANA -negative HIV - negative Retrovirus/HBsAg - negative FFA Early phase- multiple, irregular blocked fluorecscent spots with focal hyperfluorescence at the margins. Late phase - pooling of dye with minimal staining . Paravascular leakage. Disc - diffuse hyperfluorescence . B-scan ultra