Muhammad Hamizah, Chan Wei Sheng, Jaafar Juanarita, Wan Hitam Wan-Hazabbah
Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS.
Department of Ophthalmology and Visual Science, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS.
Cureus. 2025 Feb 3;17(2):e78410. doi: 10.7759/cureus.78410. eCollection 2025 Feb.
Senile scleral plaques are localized, calcified deposits typically occurring bilaterally in elderly patients and are often asymptomatic. They usually appear near the insertion of the rectus muscles and are associated with age-related changes in the sclera. In rare cases, a senile scleral plaque can occur unilaterally and may mimic the appearance of an intraocular foreign body (IOFB) especially in a post-traumatic case. We report a case of a unilateral senile scleral plaque. A 65-year-old gentleman presented with left eye pain and blurring of vision while hammering a nail into the wall at home. On examination, his visual acuity was 6/24 in the right eye and 6/60 in the left eye. On his left eye, there was a conjunctival laceration at eight o'clock. His left anterior chamber was shallow with the presence of cells 3+. His left pupil was irregular with an area of sphincter tear at eight o'clock. His left lens was posteriorly dislocated. Computed tomography (CT) of the orbit revealed a hyperdense opacity temporally, which was suspicious of an intraocular foreign body. He underwent examination under anesthesia with phacofragmentation and pars plana vitrectomy for his posteriorly dislocated crystalline lens. Intraoperatively, there was the presence of a senile scleral plaque at the temporal region, with no evidence of an intraocular foreign body. He underwent a scleral fixated intraocular lens implantation later on, and postoperatively, his visual acuity for his left eye was 6/6. He remains well with good vision throughout his follow-up. Although less common, the unilateral presentation of senile scleral plaques should be considered in the differential diagnosis of hyperdense orbital lesions in elderly patients. The potential for senile scleral plaques to mimic intraocular foreign bodies underscores the importance of thorough clinical evaluation and the careful interpretation of imaging studies in patients presenting with ocular trauma. A thorough clinical evaluation, coupled with a cautious interpretation of radiologic findings, is essential in guiding appropriate management and ensuring optimal visual outcomes.
老年巩膜斑是局限性的钙化沉积物，通常双侧发生于老年患者，且往往无症状。它们通常出现在直肌附着处附近，与巩膜的年龄相关变化有关。在罕见情况下，老年巩膜斑可单侧出现，尤其在创伤后病例中，可能类似眼内异物（IOFB）的表现。我们报告一例单侧老年巩膜斑病例。一名65岁男性在家中往墙上钉钉子时出现左眼疼痛和视力模糊。检查发现，其右眼视力为6/24，左眼视力为6/60。左眼8点钟位置有结膜裂伤。左眼前房浅，有3+的细胞。左瞳孔不规则，8点钟位置有括约肌撕裂区。左眼晶状体后脱位。眼眶计算机断层扫描（CT）显示颞侧有高密度混浊影，怀疑是眼内异物。他因晶状体后脱位接受了麻醉下检查、晶状体超声乳化吸除术和平坦部玻璃体切除术。术中发现颞侧区域有老年巩膜斑，无眼内异物证据。后来他接受了巩膜固定人工晶状体植入术，术后左眼视力为6/6。在整个随访过程中，他视力良好，情况良好。尽管老年巩膜斑单侧出现较少见，但在老年患者眼眶高密度病变的鉴别诊断中应考虑到。老年巩膜斑可能类似眼内异物，这突出了对眼外伤患者进行全面临床评估和仔细解读影像学检查结果的重要性。全面的临床评估，加上对放射学检查结果的谨慎解读，对于指导适当的治疗和确保最佳视觉效果至关重要。
