Anterior Scleritis Manifesting After Coronavirus Disease 2019: A Report of Two Cases

Abstract

Purpose: The purpose of this study was to report 2 patients with anterior scleritis manifesting after coronavirus disease 2019 (COVID-19).

Methods: The patients with confirmed COVID-19 developed anterior scleritis after their systemic symptoms were markedly improved. A thorough systemic workup identified no underlying autoimmune diseases. Ocular characteristics and safety and efficacy of systemic immunosuppressive therapy were evaluated.

Results: Case 1 was a 67-year-old woman who presented with necrotizing anterior scleritis in both eyes 3 weeks after the onset of COVID-19. One-week treatment with topical betamethasone and oral prednisolone (65 mg daily) did not result in improvement, so she was started on intravenous cyclophosphamide and subcutaneous adalimumab in addition to oral prednisolone. Necrotizing scleritis was gradually improved over 3 months. Case 2 was a 33-year-old man who presented with sectoral anterior scleritis in his right eye 2 weeks after the onset of COVID-19. He was started on topical betamethasone and oral prednisolone (85 mg daily). One week later, all signs and symptoms disappeared, and topical and oral corticosteroids were gradually tapered off over 2 weeks. There was no recurrence of respiratory symptoms or active scleritis in any cases after discontinuation of treatment.

Conclusions: These cases suggest that COVID-19 can be associated with anterior scleritis, which responds to immunosuppressive and biologic agents. Ophthalmologists should consider anterior scleritis in patients with COVID-19 who present with ocular pain and redness during the convalescent phase of the illness.

FIGURE 1.

Slit-lamp views demonstrate the course of anterior scleritis associated with COVID-19 in case 1. A and D, diffuse chemosis and engorgement of superficial and deep episcleral vessels as well as episcleral and scleral edema in both eyes and peripheral corneal epithelial defects in the left eye at the time of presentation. B and E, necrotic areas 1 week after treatment with topical and systemic corticosteroids. C and F, improved scleritis 3 months after treatment with systemic immunosuppressive and biologic agents.