Scleritis is inflammation of sclera which can be total or sectoral. It can occur due to different causes such as trauma or by microorganisms.

2. Prepared by: Dr. Sayed Ehsanulah Hashemi
Under Observation of: Dr. Ibrahim Sharifi & Dr. Sulaiman Shirzad
SCLERITIS

3. OBJECTIVES
• Definition
• Incidence
• Classification
• Signs&Symptoms.
• Specificinvestigations.
• Treatment

4. DEFINITION
Scleritis is a granulomatous inflammation of the
sclera.

5. Scleritis

6. Episcleritis

7. Incidence
It is much less common than episcleritis.
Women are commonly affected in the 5th and
6th decade.
Usually bilateral.

8. Pathology
• There is dense infiltration of the scleral tissue by
lymphocytes.

9. Classification
1.Anterior scleritis(95%)
a.Non-necrotizing:diffuse or nodular
b.Necrotizing: with or without
inflammation
2.Posterior scleritis(5%)

10. Associated Systemic
Diseases
• 45% of patients may have the following
associated diseases:
1.Rheumatoid arthritis
2.Connective issue disorders
3. Miscellaneous: relapsing polychondritis,herpes
zoster,gout,surgically
induced scleritis etc

11. CLINICAL FEATURES

12. Anterior non-
necrotizing scleritis
1.Presentation: Severe discomfort,tenderness and watering of eyes.
2.Signs: a)Diffuse scleritis-Widespread inflammation
Distortion of vascular pattern
Benign progression
b)Nodular Scleritis-Nodular appearance
Intermediate severity

13. Anterior diffuse scleritis

14. Anterior nodular scleritis

15. Anterior necrotizing
scleritis with
inflammation
1.Presentation: Most severe form with gradual onset of pain and localized
redness .
2. Signs: a) Distortion or occlusion of blood vessels
b) Development of scleral necrosis
c) Gradual spread of necrosis around the
d) Presence of associated
disease involving
globe
anterior uveitis indicative of very severe
ciliary body
Complications: corneal involvement,cataract,glaucoma.

16. Anterior necrotizing scleritis with
inflammation

17. Anterior necrotizing
scleritis without
inflammation
1.
2.
3.
Presentation: Asymptomatic
Signs: Starts with a yellow necrotic patch
Large areas of uvea become exposed
Complications: Perforation rare unless IOP elevated

18. Anterior necrotizing scleritis without
inflammation(scleromalacia perforans)

19. Posterior scleritis
• Presentation: Variable,pain and visual impairment
• Signs: Eyelid oedema
Proptosis
Opthalmoplegia
Associated anterior scleritis present in 40% of cases
• Ophthalmoscopy: Disc swelling
Macular oedema
Retinal detachment
Vitritis Ring
Choroidal detachment
Choroidal folds
Subretinal mass
Intraretinal white deposits

20. Posterior scleritis

21. Posterior scleritis(cont…)
• D/D: Optic neuritis
Rhegmatogenous RD
Choroidal tumour
Orbital inflammatory disease or mass
Uveal effusion syndrome
Harada disease
• USG: Thickening of posterior sclera with fluid in tenon space
• CT: Thickening of posterior sclera with fluid in tenon space

22. Choroidal folds over macula

23. B-scan

24. Treatment
• ANTERIOR NON-NECROTIZING SCLERITIS:
Oral NSAIDS(flurbiprofen 100mg x tds)
Oral prednisolone(40-80mg x od)
Combination therapy of NSAIDS and lower dose
steroids.
• ANTERIOR NECROTIZING SCLERITIS WITH INFLAMMATION:
Oral prednisolone(60-120mg x od tapered accordingly)
Immunosuppressive agents
Combined therapy with pulsed i.v methylprednsolone(500-1000mg)
and cyclophosphamide(500mg)

25. Treatment(cont…)
•
•
ANTERIOR NECROTIZING SCLERITIS WITHOUT
INFLAMMATION: No effective treatment
POSTERIOR SCLERITIS:
a)Elderly patients with associated systemic disease are treated in the
same way as those with anterior necrotizing scleritis.
b) Young patients without associated systemic disease usually
respond well to NSAIDS.

26. Surgical treatment
• Extreme scleral thinning requires reinforcement.
• Corneal marginal ulceration or keratolysis may require corneal grafting.