- 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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