Photoreceptor disruption secondary to posterior vitreous detachment as visualized using high-speed ultrahigh-resolution optical coherence tomography.

Comment. Scleral inflammatory disease is a deep and destructive inflammation presumed to be incited by autoimmune system dysregulation and is often classified on the basis of the site of pathologic findings and severity of inflammation. Scleritis is characterized by edema and inflammatory cell infiltration of the sclera and is commonly associated with identifiable systemic disease and often with ocular complications. The development of a spontaneous filtering bleb with consequential hypotony is an unusual complication of anterior scleritis, and, to our knowledge, our case is the first reported. Thinning secondary to scleral inflammation, with a resultant focal aqueous shunt and collection external to the subconjunctival or subTenon space, analogous to a deliberate guarded filtration procedure, is the presumed underlying mechanism. Ultrasound biomicroscopy to quantify scleral thinning was unavailable; however, its potential role in the assessment of scleritis subtypes, disclosing disease progression and judging treatment efficacy, has been demonstrated. This unusual complication emphasizes the destructive nature of scleral inflammatory processes and a management dilemma between the risks of infection and hypotony-related complications with observation compared with the potential to incite further, more substantial scleral inflammation with a surgical approach.