Unilateral painful external ophthalmoplegia as the first manifestation of combined anterior and posterior scleritis

Purpose Posterior scleritis (PS) is a rare form of ocular inflammation. It can be idiopathic or associated with systemic disorders in 40%–50% of cases. PS is characterized by several different clinical manifestations like severe pain especially during eye movements and in some cases decreased vision. It can include changes in choroid, retina and optic nerve and associate anterior scleritis. We present a case of unilateral painful ophthalmoplegia as the first manifestation of combined anterior and posterior scleritis. Methods An otherwise healthy 55‐year‐old man complained with acute diplopia and painful ophthalmoplegia in his left eye. Findings on examination were conjunctival quemosis, moderate hyperemia and limitation of ocular movements in all directions. Best‐corrected visual acuity (BCVA) was 20/20 in both eyes. Goldmann applanation intraocular pressure was 18 mmHg in right eye and 28 mmHg in left eye. Fundus examination was normal. Contrast‐enhanced CT scan showed marked anterior and posterior scleral thickening of the left eye. In the systemic examination, routine blood tests, autoimmune and infectious markers were normal. Results Treatment was initiated with oral prednisolone 1 mg/kg/day. After 7 days, the patient′s signs and symptoms had improved. Following one month of treatment scleritis had disappeared. One year later, the patient is asymptomatic without any recurrences. Conclusions Opthalmologist should be aware of the possibility of a misdiagnosed posterior scleritis in a patient with clinical settings of anterior scleritis like diplopia or ophthalmoplegia.