Scleritis

Anterior scleritis

Non-necrotizing

• Diffuse: benign
• Nodular

Necrotizing

• Inflammatory
• Non-inflammatory: scleromalacia perforans

Posterior scleritis (20%)

• 80% have concomitant anterior scleritis
• Poor visual prognosis

Presentation

• Disc swelling
• Exudative RD (cp. VKH)
• Subretinal mass
• Ring choroidal detachment
• Vitritis
• Macular oedema

Systemic associations

• Infective

  • Herpes zoster
  • TB
  • Syphilis

• Non-infective

  • RA
  • SLE
  • GPA
  • PAN
  • Relapsing polychondritis
  • Surgically induced necrotizing scleritis

Tests

• FBC, U&Es, LFTs
• ESR, CRP
• VDRL
• ANA, ANCA
• CXR
• B-scan: T-sign in posterior scleritis due to fluid in sub-Tenon’s space

Management

• Focussed initially on systemic disease
• Anterior, non-necrotizing: NSAIDs
• Anterior, necrotizing and inflammatory: systemic steroids and immunosuppressants
• Posterior: systemic steroids