Supplementary Material for: Idiopathic Posterior Scleritis Complicated by Optic Perineuritis and Ocular Motility Disorder Successfully Controlled with Adalimumab: A Case Report

Introduction: This report describes a rare case of idiopathic orbital inflammation with posterior scleritis complicated by optic perineuritis and ocular motility disorder.
Case presentation: A 22-year-old woman presented with right ocular pain, eyelid swelling, and blurring of vision for 5 days. Her best corrected visual acuity was 20/20 in the right eye, although a myopic shift was noted. An ocular motility disorder was identified on examination. Slit lamp and fundus examinations revealed diffuse scleral injection, anterior chamber inflammation, and serous retinal detachment. B-scan ultrasound showed thickening of the choroid and sclera. Gadolinium-enhanced MRI revealed marked thickening and enhancement of the right optic nerve sheath. Humphrey visual field testing showed an enlarged blind spot and an inferior field defect. The systemic work-up and laboratory tests were unremarkable, aside from elevated CRP and ESR. The patient was diagnosed with idiopathic orbital inflammation with posterior scleritis, optic perineuritis, and ocular motility disorder. Treatment with oral prednisolone (50 mg/day) improved all ocular findings, but a relapse occurred while tapering to 10 mg/day. The symptoms resolved after increasing the dose of prednisolone, and adalimumab was added to prevent recurrence. Adalimumab was continued while tapering prednisolone and replacing it with oral hydrocortisone for secondary adrenal insufficiency. Six months after the discontinuation of prednisolone, the patient remains in remission.
Conclusion: This rare case of idiopathic orbital inflammation with posterior scleritis, optic perineuritis, and ocular motility disorder was successfully controlled with adalimumab after relapse, suggesting its efficacy in preventing recurrence.