Retrospective case report on asymptomatic sclerochoroidal calcification

Methods and Materials: Sclerochoroidal calcification is a rare, benign condition characterised by calcium deposition within the sclera, typically in elderly patients, and is often discovered incidentally. It can masquerade as a retinal or choroidal mass, leading to unnecessary referrals and investigations. We report a case of asymptomatic sclerochoroidal calcification identified following referral for a suspected retinal lesion detected during a routine optician visit.

Visual acuity was unaffected, and anterior segment examination was unremarkable. Colour fundus photography demonstrated a well-defined, yellow-white, elevated lesion located in the superotemporal posterior pole, with smooth margins and no associated subretinal fluid, haemorrhage, or pigmentary disturbance. The lesion’s location corresponded anatomically to the site of oblique extraocular muscle insertion, a recognised predilection site for sclerochoroidal calcification.

Multimodal imaging was undertaken to further characterise the lesion. Optical coherence tomography revealed focal underlying choroidal thinning without elevation of the retinal layers; there was no disruption of the retinal architecture. Fundus autofluorescence imaging demonstrated a corresponding area of hypoautofluorescence, consistent with dense calcification. B-scan ultrasonography showed a highly reflective lesion with posterior acoustic shadowing.

Results: Given the characteristic clinical appearance, imaging findings, and typical anatomical location, a diagnosis of sclerochoroidal calcification was established. Systemic evaluation did not identify any associated metabolic or endocrine abnormalities, including disorders of calcium or phosphate metabolism. The patient was reassured, and observation at 6 months follow up did not show any changes.

Conclusion: This case illustrates the importance of recognising sclerochoroidal calcification as a benign entity and highlights the value of widefield imaging and multimodal assessment in differentiating it from sight-threatening choroidal pathology. Awareness of its typical imaging features and predilection for sites of extraocular muscle insertion can prevent misdiagnosis, unnecessary investigations, and patient anxiety.