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1、MULTI-NODULARPOSTERIORSCLERITISDrNilutpalBorah,M.S.GuwahatiEyeInstituteandResearchCenterAssam,India15yearoldgirlwasadmittedinaneurologyhospitalsuspectingofintracraniallesion.Referredforeyeexamination.OcularhistoryOS–1week-sudden,complete,painfullossofvisionwithswellin
2、g.Painaroundtheleftperiorbitalregion,radiatingtowardslefthemicranium,leftearandleftsideoftheneck.Nauseaandvomiting.Pasthistory5monthsago-OS–pain,redness,dimnessofvision.Treatmentwasincomplete.1yearago-OD-similarepisodeofpain&redness.Notreatment.ClinicalfindingsTenderg
3、lobeVA-OD6/6,OSPLnegative(maxilluminationwithIDO)OS-RAPD+Lidsswollen,mildsuperiorconjunctivalandepiscleralcongestion.flare+,cell+,fibrinousdepositiononcrystallinelensFundus-OD-vitreouscells+OS-vitreouscells++,Severalsmallandmedium,yellowish,sub-retinalmasslesions.Reti
4、nalblothemorrhage,exudativedetachment.Disc–hyperaemic&edematousInvestigationsBloodR/E-ESR40mm(1sthr)Hb9.0%UrineR/E-AlbumintracePuscell2-4/HPFEpithelialcells1-2/HPFInvestigationsSystemicexaminations-unremarkable.Paranasalsinuses-normalCTScanbrain-normalX-ray-chest-norm
5、alStoolR/E-ova&cysts-absentMontouxtest-negativeVDRL-non-reactiveANA-negativeHIV-negativeRetrovirus/HBsAg-negativeFFAEarlyphase-multiple,irregularblockedfluorecscentspotswithfocalhyperfluorescenceatthemargins.Latephase-poolingofdyewithminimalstaining.Paravascularleakag
6、e.Disc-diffusehyperfluorescence.B-scanultrasonographyMultiple,irregularmasslesionsinvolvingchoroidandsclera.Moderatetohighinternalreflectivity.Choroidandsclera–grosslythickenedPeribulberedema-present‘T’sign-positiveB–scanshowingresolutionofscleritisDiagnosisOS–Multino
7、dularposteriorscleritisAnteriorscleritisInflammatoryopticneuritisExudativeretinaldetachmentTreatmentIntravenousmethylprednisolone-1gmdailyX5daysTopicalsteroid&cycloplegicE/DropFollowup5thday–VA–FC-1meterSlit-lampandfundusexaminationshowedimprovementTreatmentcontinuedw
8、ith-Oralsteroids(1mg/kg),topicalsteroideyedropFollowup3weeks–VA-6/18pSlit-lampandfundusexamination–furtherimprovementTreatme
