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  • Posterior scleritis after COVID-19 vaccination can look like uveal melanoma

    Ocular Pathology/Oncology

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

    Negretti G, Zeiger J, Cherkas E, et al. Eye (London), July 2023

    In a small cohort of patients who developed posterior scleritis after a COVID-19 event, posterior scleritis presented with an elevated mass that prompted concerns for uveal melanoma. A few key features can help differentiate the two conditions.

    Study design

    This was a single-institution retrospective case series of patients with posterior scleritis who were referred due to concerns for intraocular tumor. Patients who were referred between February 2021 and June 2022 and had a history of COVID-19 vaccination or COVID-19 infection were included.

    Outcomes

    Among 8 patients in total, 6 patients had a history of COVID-19 vaccination, and 2 patients had a history of both COVID-19 vaccination and COVID-19 infection. Patients were referred at mean age of 59 years, and 5 of 8 patients cited blurry vision with pain as their main presenting symptom. The key features leading to diagnosis of posterior scleritis in these patients (as opposed to uveal melanoma) included pain in 6 patients, Tenon's edema in 5 patients, and scleral nodule with medium to high internal reflectivity by ultrasound in 4 patients. In 5 of 6 patients with available follow-up, the scleral nodule resolved within 2 months.

    Limitations

    This was a small case series with a mixed population of patients who had either COVID-19 vaccination alone or both COVID-19 infection and COVID-19 vaccination. Although there was a historical association with COVID-19 events and posterior scleritis in the case series, the cause of scleritis in these patients cannot be definitively proven.

    Clinical significance

    Posterior scleritis may develop following COVID-19 vaccination or COVID-19 infection, and clinical features of posterior scleritis can mimic those of an intraocular tumor. Key features that can help differentiate posterior scleritis from uveal melanoma include pain as a primary presenting symptom and the presence of an echodense nodule with associated Tenon's edema on B-scan.

    Financial Disclosures: Dr. Lauren Dalvin discloses financial relationships with Leonard and Mary Lou Hoeft Career Development Award Fund, National Cancer Institute, and National Center for Advancing Translational Science (Grant Support).