PMC4889796_01
Clinical evolution of anterior nodular scleritis associated with varicella zoster virus. (a) Initial reddish scleral nodule with dilated vessels. (b) Clinical improvement with oral prednisolone 40 mg daily, less hyperemia, and flattening of the nodule. (c) Clinical resolution after methotrexate therapy; the underlying uveal tissue is visible through the thinned sclera giving it a blue-gray appearance.
CRIOPM2016-8519394.001.jpg
PMC4889796_01_CRIOPM2016-8519394.001.jpg
fig1
Two months later and under treatment with oral valacyclovir (500 mg daily), her right eye developed a reddish scleral nodule at 11 o'clock (Figure 1(a)) and tenderness on palpation. Therapy was changed to oral prednisolone 1 mg/Kg/day and an improvement of the scleritis occurred (Figure 1(b)); however, it remained stable for several weeks, without additional improvement. Subsequently, weekly methotrexate 15 mg was introduced, allowing the suspension of the prednisolone, with clinical resolution of scleritis in 8 weeks (Figure 1(c)).