A Challenging Case of Scleritis with Refractory Pressure Control

Abstract

Systemic pathologies frequently show detectable signs during ophthalmologic assessments, and early identification of these manifestations can profoundly influence the disease’s subsequent course. A 62-year-old man presented to the emergency department of the Ophthalmology Department of Centro Hospitalar e Universitário de São João with bilateral painful red eye spanning the previous three months without concurrent ophthalmologic or systemic symptoms. Anterior segment examination assessment revealed bilateral diffuse, non-necrotizing, scleritis. Ocular hypertension (35 mmHg in the right eye and 40 mmHg in the left eye) was present. Past medical history included bilateral juvenile open-angle glaucoma. Systemic work-up results later disclosed anti-neutrophil cytoplasmatic auto-antibodies – proteinase 3 (ANCA-PR3) levels exceeding 200 U/mL. Granulomatosis with polyangiitis is known to elicit a range of ophthalmologic manifestations, affecting nearly 50% of the patients. This case underscores the importance of pursuing comprehensive systemic evaluations in patients with scleritis, even in the absence of overt systemic symptoms.