Scleritis
Related Subjects:
|Episcleritis
|Scleritis
|Assessing a Red eye
|Acute Angle Closure Glaucoma
|Allergic and Infective Conjunctivitis
|Anterior and Posterior Uveitis
|Atropine Sulfate
|Herpes simplex keratitis (HSK)
|Acute Blepharitis
|Chalazion
๐ About
- ๐ Scleritis is a vision-threatening emergency โ same-day referral to Ophthalmology.
- ๐ด It involves painful, destructive inflammation of the sclera, often associated with systemic disease.
๐งฉ Rheumatological Associations
- ๐คฒ Rheumatoid arthritis (most common)
- ๐ฆ Inflammatory bowel disease (Crohnโs, Ulcerative Colitis)
- ๐ซ Granulomatosis with polyangiitis (Wegenerโs)
- ๐ฉธ Polyarteritis nodosa (PAN), Giant Cell Arteritis (GCA), Systemic Lupus Erythematosus (SLE)
- ๐ฆด Seronegative spondyloarthropathies
- ๐ง Relapsing polychondritis
๐ฆ Infective Associations
- ๐ฆ Herpes Zoster Ophthalmicus
- ๐งซ Pseudomonas & other bacterial infections
- ๐ Fungal and protozoal infections
- ๐งฌ Syphilis, Tuberculosis, Sarcoidosis
๐๏ธ Clinical Features
- โก Severe pain, worsens on eye movement, globe is tender.
- ๐ Pain may wake patient at night; photophobia common.
- ๐๏ธ Anterior scleritis: diffuse or nodular scleral erythema.
- ๐๏ธ Posterior scleritis: reduced vision, retinal/choroidal/extraocular muscle oedema.
- โ ๏ธ White patches of necrosis (pallor) within erythema โ suggests systemic vasculitis.
- ๐ต Chronic disease may cause scleral thinning (scleromalacia), exposing the blue choroid.
๐ฌ Investigations
- ๐ฉบ Clinical diagnosis โ urgent ophthalmology assessment.
- ๐งช Bloods: FBC, ESR/CRP, ANA, ANCA, RF, complement, syphilis serology.
- ๐ฆ Infective screen: TB, syphilis, viral PCR if relevant.
- ๐ผ๏ธ Imaging: B-scan ultrasound/MRI orbit if posterior scleritis suspected.
- ๐ Consider systemic work-up if vasculitis suspected.
๐งซ Pathology
- Autoimmune granulomatous inflammation with vasculitis of scleral vessels.
- May progress to necrosis and scleral thinning.
- Immune-complex mediated in many rheumatological causes.
๐ Management
- ๐ฅ Necrotising scleritis โ requires aggressive systemic immunosuppression (high-dose steroids + DMARDs or biologics).
- ๐ฟ Non-necrotising scleritis โ topical/oral NSAIDs, topical steroids, or oral corticosteroids.
- ๐ Severe/refractory disease โ IV steroids, immunosuppressants (methotrexate, cyclophosphamide, azathioprine), TNF-ฮฑ inhibitors.
- ๐ Always investigate & treat underlying systemic associations.
- ๐ฉโโ๏ธ Close liaison with rheumatology & ophthalmology teams.
๐ References
- British Society for Rheumatology: Guidelines for the management of ocular inflammatory disease.
- BMJ Best Practice: Scleritis overview.
- Watson & Hayreh: Scleritis and episcleritis, Oxford University Press.
