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Posterior scleritis following COVID-19 vaccination or infection simulating uveal melanoma in 8 consecutive patients

Eye volume 38, pages 185–191 (2024)Cite this article

Subjects

Abstract

Objectives

To determine clinical features and outcomes of posterior scleritis masquerading as uveal melanoma following vaccination against COVID-19 and/or COVID-19 infection.

Subjects/Methods

All patients with posterior scleritis referred to our service to rule out intraocular tumour between February 2021 and June 2022, who previously had COVID-19 vaccination and/or infection (n = 8). A retrospective detailed review of patient charts and imaging was carried out.

Results

Previous COVID-19 vaccination was documented in 6 patients (75%) and previous COVID-19 infection and vaccination in 2 patients (25%). Demographic features included mean age of 59 years (median 68, range 5–86 years), white race (n = 7, 87%), and male sex (n = 5, 63%). Mean visual acuity at presentation was 0.24 LogMAR (median 0.18, range 0.0–0.70). The main presenting symptom was blurred vision with pain (n = 5, 63%). Features that suggested scleritis and not uveal melanoma included pain (n = 6, 75%), anterior scleritis (n = 3, 38%), disc oedema (n = 1, 13%), choroidal detachment (n = 3, 38%), choroidal folds (n = 3, 38%), diffusely thickened scleral wall on ultrasonography (n = 2, 25%), Tenon’s oedema (n = 5, 63%), and scleral nodule with medium/high internal reflectivity on ultrasonography (n = 4, 50%). Follow-up information at mean of 2 months (range 0.25–7 months) revealed visual acuity at date last seen was mean 0.30 LogMAR (median 0.29, range 0.0–0.54). By 2 months, resolution of “tumour” was noted in 5/6 (83%) patients with follow-up.

Conclusions

Posterior scleritis following COVID-19 vaccination and/or infection can masquerade as choroidal melanoma. At 2 months duration, partial or complete resolution of features with minimal visual consequence was noted.

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Fig. 1: Posterior scleritis and choroidal effusion appearing 24 weeks following COVID-19 vaccination.
Fig. 2: Posterior scleritis with choroidal effusion appearing 3 weeks after testing positive for COVID-19 infection.

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Data availability

All patients consented to the researchers using their data for the completion of this manuscript. Under the Health Insurance Portability and Accountability Act (HIPPA), researchers cannot share this data publicly. Carol L. Shields, M.D. has had full access to all the data in the study and takes responsibility for the integrity of the data.

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Funding

Funding

Support was provided in part by the Moorfields Eye Charity (GN), TFC Frost Charitable Trust (GN) the Worshipful Company of Spectacle Makers Charity (GN), and the Eye Tumour Research Foundation, Philadelphia, PA (CLS). The funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.

Author information

Author notes

  1. Elliot Cherkas

    Present address: Casey Eye Institute, OHSU, Portland, OR, USA

Authors and Affiliations

  1. Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA

    Guy S. Negretti, Jennifer S. Zeiger, Elliot Cherkas & Carol L. Shields

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  1. Guy S. Negretti
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  2. Jennifer S. Zeiger
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  3. Elliot Cherkas
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Contributions

GN, JSZ, EC, and CLS all contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.

Corresponding author

Correspondence to Carol L. Shields.

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Negretti, G.S., Zeiger, J.S., Cherkas, E. et al. Posterior scleritis following COVID-19 vaccination or infection simulating uveal melanoma in 8 consecutive patients. Eye 38, 185–191 (2024). https://doi.org/10.1038/s41433-023-02656-z

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