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Non Infectious
Diffuse Anterior Scleritis

  • Clinical features:
    • Granulomatous inflammation of the sclera.
    • May present in association with systemic diseases i.e. rheumatoid arthritis, SLE, polyarteritis nodosa, or Wegener's granulomatosis.
    • Symptoms: ocular pain with or without decreased vision.
  • May be self-limiting or progress to necotizing process that may be potentially blinding.
  • May be classified into non-necrotizing or necrotizing anterior scleritis and non-necrotizing or necrotizing posterior scleritis.
  • Non-necrotizing inflammation may be differentiated into nodular and diffuse scleritis.
  • Complications: scleral thinning (especially in the chronic recurrent scleritis), scleromalacia, scleral perforation, sclerosing keratitis, peripheral corneal melting, uveitis, cataract, macula edema, retinal detachment and choroidal granuloma.
  • Work up:
    • Systemic rheumatology evaluation.
    • Always rule out infection in cases of necrotizing scleritis.
  • Treatment: systemic NSAIDs, systemic or topical corticosteroids, cyclophosphamide, cyclosporin or other immunosuppressive therapies.

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