gms | German Medical Science

Introduction: A 54-year old woman first presented with painful ocular inflammation and marked injection of her right eye over a 3-day period. After treatment with topical steroids the symptoms improved. Six weeks later the patient returned with redness of her right eye and a scleral mass.

Methods: An episcleral nodular mass presented in the nasal upper quadrant of her right eye. In addition an amelanotic choroidal mass right behind the ciliary body was evident. Gonioscopy showed no pathological features. A and B-scan echography showed a medium to high-reflective solid choroidal mass (2.4x6.0 mm). Ultrasound biomicroscopy presented the involvement of the ciliary body. MRI demonstrated a transscleral and intraocular mass in the superonasal quadrant of the right globe.

Results: Five days after topical treatment with prednisolone the nodular mass decreased in size. Further examinations revealed no systemic disease. After tree month of topical prednisolone therapy the nodular mass disapeared and left behind a thin area of the sclera.

Discussion: The scleral and choroidal changes were suspicious of amelanotic melanoma or ciliary body adenoma. However, the response to topical corticosteroid therapy was consistent with nodular scleritis. Nodular scleritis can present as an intraocular tumor and must be clinically differentiated from choroidal melanoma or other intraocular tumors. In these cases additional A-scan echography can be very helpful in diagnosis.