Categories
Ocular System

Scleritis

Inflammation of the sclera.

Aetiology

Associated conditions:

  • Rheumatoid arthritis (RA) (M/C cause)
  • Wegener’s disease
  • Relapsing polychondritis
  • Systemic lupus erythematosus (SLE)
  • Inflammatory bowel disease (IBD)
  • Polyarteritis nodosa
  • Trauma owing to surgery or other causes

Classification

Watson and Hayreh classification:

Distribution of various scleritis subtypes. | Al Barqi, M., Behrens, A., & Alfawaz, A. M. (2015). Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia. International journal of ophthalmology, 8(6), 1215–1219. https://doi.org/10.3980/j.issn.2222-3959.2015.06.25

Anterior scleritis:

  • Diffuse (M/C presentation, 60% cases)
  • Nodular
  • Necrotizing with inflammation (M/severe presentation)
  • Scleromalacia perforans: necrotizing without inflammation

Posterior scleritis

Involvement of the sclera by inflammation posterior to the insertion of the medial and lateral rectus muscles.
B-scan ultrasonography of posterior scleritis. Idiopathic posterior scleritis in a 51 year-old woman. The figure demonstrates thickened sclera with hypoechogenic fluid in the space behind the sclera. | Galor, A., & Thorne, J. E. (2007). Scleritis and peripheral ulcerative keratitis. Rheumatic diseases clinics of North America, 33(4), 835–vii. https://doi.org/10.1016/j.rdc.2007.08.002

Clinical features

Anterior scleritis:

Redness and globe tenderness

Posterior scleritis:

Reduced vision with/without pain

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