DR. NITHIN KESHAV SRINIVASAN

DR. NAVEEN KESHAV S

Abstract

55-year-old gentleman presented with redness and pain in left eye for 6 months duration. Visual acuity in the affected eye was PL+. He was treated elsewhere with topical and oral steroids for 6 months but symptoms persisted. Ocular examination showed congested sclera with a 6 x 4 mm brownish flat lesion under the conjunctiva in the supero-temporal quadrant. The lesion was tender. Cornea clear, anterior chamber showed the presence of cells 2+ and flare 2+. Black cataract +. B scan showed long-standing retinal detachment. He underwent uveitic screening and was positive for RA factor and referred to rheumatologist. After complete rheumat work up he was started on intravenous cyclophosphamide 3 cycles and then on Methotrexate maintenance dose. 6 months later, the eye is quiet with no pain with minimal redness, the scleritis lesion is getting better and the impending melt is prevented. This picture is presented to emphasise the role of higher immunosuppressants in necrotising scleritis.