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

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.