Abstract

Posterior scleritis, a rare condition, often eludes diagnosis due to its diverse clinical presentation. It involves painful inflammation of the sclera behind the ora serrata. About 10% of scleritis cases are posterior, with half associated with systemic diseases like RA, lupus, and granulomatous polyangiitis. A comprehensive systemic evaluation is crucial. We present the case of a 10-year-old girl with a painful right eye swelling, accompanied by symptoms such as nausea, vomiting, fever, and decreased appetite. VA remains normal, clinical signs include eyelid edema, chemosis, photophobia, no RAPD, and disc edema. Systemic inv reveal elevated ESR and CRP. Brain and orbital MRI indicate possible orbital cellulitis or idiopathic orbital inflammation in the right eye. Initial treatment with IV antibiotics proves ineffective, and oral steroids offer temporary relief but result in symptom recurrence upon tapering. Given the need for prolonged immunosuppression, she's initiated on oral MTX