Fortunately, this consequence was easily managed by the hypotensive agent dorzolamide alone here, which may not have been necessary had a lower potency steroid been used initially instead.
However, for others, such as half of the general pediatric population, there is a known greater risk of sustained ocular hypertension with topical diï¬uprednate, and striking implications for blindness from glaucoma later in life.2
In this case, it is easy to be led astray by positive Lyme serology. Though Lyme disease is an important cause of scleritis, the history of treatment failure and low pretest probability of truly having the disease (as Tennessee has a low incidence rate and the patient had not traveled to endemic areas) in the setting of persistent inï¬ammation, and low inherent test speciï¬city,3 all warranted consideration of other causes of scleritis.
It is important to consider focused laboratory testing with a thoughtful differential diagnosis in mind, rather than ordering a large battery of tests.