Focal Scleral Nodule

Category(ies): Retina / Vitreous

Contributor: Lauren A. Tomlinson MD; Nicole A. Somani MD; Elaine M. Binkley MD

Photographer: Alexandria Steggall

Posted: 06/30/2025

Focal scleral nodules (previously called solitary idiopathic choroiditis or unifocal helioid choroiditis) are rare, amelanotic, intrascleral lesions localized to the posterior segment of the eye. They are often elevated and yellow or white in color. These lesions are typically asymptomatic and are incidentally found on dilated fundus exam. It is uncertain whether the lesions are congenital or the result of an old inflammatory process. In the case shown here, there was overlying retinal pigment epithelium disruption without subretinal fluid. If asymptomatic, these lesions are observed without intervention.

Figure 1: Fundus photography of the right eye showing a yellow-orange lesion inferior to the inferior arcade. Atrophy can be seen at the apex of the lesion — Figure 1: Fundus photography of the right eye showing a yellow-orange lesion inferior to the inferior arcade.

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Figure 2: OCT macula of the right eye showing elevation of the lesion as well as mild subretinal high-reflective material over the apex. There was no subretinal fluid. The lesion appears to originate from the sclera, compressing the choroid above it. — Figure 2: Dedicated OCT line scan over the lesion shows hyporeflective lesion in the sclera resulting in domed elevation of the overlying choroid and retina, without subretinal fluid.

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Figure 3: Longitudinal B-scan ocular ultrasound of the right eye at the 7 o�clock position demonstrating a small, localized calcified lesion inferotemporal to the nerve, corresponding to the focal scleral nodule. — Figure 3: Longitudinal B-scan ocular ultrasound of the right eye at the 7 o'clock position demonstrating a small, localized calcified lesion inferotemporal to the nerve, corresponding to the focal scleral nodule.

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Reference(s):

Shields JA, Shields CL, Demirci H, Hanovar S. Solitary idiopathic choroiditis: the Richard B. Weaver lecture. Arch Ophthalmol. 2002 Mar;120(3):311-9. doi: 10.1001/archopht.120.3.311. PMID: 11879134.
Fung AT, Waldstein SM, Gal-Or O, Pellegrini M, Preziosa C, Shields JA, Welch RJ, Dolz-Marco R, Sarraf D, Nagiel A, Lalane R, Jung JJ, Ghazi NG, Ramtohul P, Arnold JJ, Sakurada Y, Choudhry N, Balaratnasingam C, Freund KB, Shields CL. Focal Scleral Nodule: A New Name for Solitary Idiopathic Choroiditis and Unifocal Helioid Choroiditis. Ophthalmology. 2020 Nov;127(11):1567-1577. Epub 2020 Apr 22. PMID: 32507351.
Fung AT, Kaliki S, Shields CL, Mashayekhi A, Shields JA. Solitary idiopathic choroiditis: findings on enhanced depth imaging optical coherence tomography in 10 cases. Ophthalmology. 2013 Apr;120(4):852-8. Epub 2012 Dec 12. PMID: 23246121.

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Ophthalmology and Visual Sciences