Nodular Posterior Scleritis Mimicking Non-pigmented Choroidal Melanoma: A Case Report and Literature Review

Nodular posterior scleritis is an uncommon inflammatory disorder of the eye characterized by nodular lesions that may be similar to other intraocular conditions such as choroidal melanoma, leading to diagnostic difficulties. This case report and literature review aims to evaluate the demographics, modalities, treatment, and outcomes of nodular posterior scleritis. We describe a 41-year-old female patient who presented with diminished vision in her left eye. Based on an examination and fundus findings, it was suspected to be non-pigmented choroidal melanoma. A multidisciplinary evaluation did not show evidence of an underlying systemic disease. The diagnosis was later confirmed to be nodular posterior scleritis based on imaging features and response to treatment. Previous reports of nodular posterior scleritis mimicking choroidal melanoma were viewed. The patient was treated with systemic corticosteroids (prednisolone 40 mg daily), topical steroids, and mydriatic drops. Symptoms resolved and visual acuity improved in the interim, as demonstrated at the six-month follow-up. This case underscores the significance of a comprehensive diagnostic workup to make an accurate diagnosis based on careful imaging and clinical evaluation that will aid in optimal management. Although MRI has largely replaced B-scan ultrasonography for imaging most intraocular masses, B-scan ultrasonography remains an important part of the initial assessment in cases of posterior scleritis to differentiate it from malignant masquerade syndromes and direct the appropriate therapeutic strategy.