Severe idiopathic posterior scleritis in children.

Posterior scleritis is an uncommon condition that usually occurs in adults and the diagnosis is often missed. It is even more rare in children. We report five cases of the disease in children. The patients presented with severe pain in an inflamed eye and usually had orbital signs with lid swelling and limitation of extraocular movements; four of the five had optic disc swelling and two had exudative retinal detachments. The diagnosis was confirmed on B-scan ultrasonography and CT scanning and no child had clinical or laboratory evidence of associated systemic disease. The disease took a protracted course and all the children required long-term systemic immunosuppression (15-27 months), which was well tolerated. All children retained good vision and were either off treatment or on a small dose of immunosuppression at last follow-up. This condition, although rare, should be recognised in children as part of the differential diagnosis of acute orbital inflammation.