Senile Scleral Plaque Mimicking an Intraocular Foreign Body

Senile scleral plaques are localized, calcified deposits typically occurring bilaterally in elderly patients and are often asymptomatic. They usually appear near the insertion of the rectus muscles and are associated with age-related changes in the sclera. In rare cases, a senile scleral plaque can occur unilaterally and may mimic the appearance of an intraocular foreign body (IOFB) especially in a post-traumatic case. We report a case of a unilateral senile scleral plaque. A 65-year-old gentleman presented with left eye pain and blurring of vision while hammering a nail into the wall at home. On examination, his visual acuity was 6/24 in the right eye and 6/60 in the left eye. On his left eye, there was a conjunctival laceration at eight o'clock. His left anterior chamber was shallow with the presence of cells 3+. His left pupil was irregular with an area of sphincter tear at eight o'clock. His left lens was posteriorly dislocated. Computed tomography (CT) of the orbit revealed a hyperdense opacity temporally, which was suspicious of an intraocular foreign body. He underwent examination under anesthesia with phacofragmentation and pars plana vitrectomy for his posteriorly dislocated crystalline lens. Intraoperatively, there was the presence of a senile scleral plaque at the temporal region, with no evidence of an intraocular foreign body. He underwent a scleral fixated intraocular lens implantation later on, and postoperatively, his visual acuity for his left eye was 6/6. He remains well with good vision throughout his follow-up. Although less common, the unilateral presentation of senile scleral plaques should be considered in the differential diagnosis of hyperdense orbital lesions in elderly patients. The potential for senile scleral plaques to mimic intraocular foreign bodies underscores the importance of thorough clinical evaluation and the careful interpretation of imaging studies in patients presenting with ocular trauma. A thorough clinical evaluation, coupled with a cautious interpretation of radiologic findings, is essential in guiding appropriate management and ensuring optimal visual outcomes.