Inflammation of sclera

1. Dr Rupesh Ekkaluri M.S (ayu)
Inflammatory disease of Sclera

2. Scleritis refers to an inflammation of the sclera proper
• It is a comparatively serious disease which may cause visual impairment and
even loss of the eye if treated inadequately.
• Fortunately, its incidence is much less than that of episcleritis.
• Jt usually occurs in elderly patients (40-70 years) involving females more than
the males.

4. 4
• Especially rheumatoid arthritis, is the most common association.
• About 0.5% of patients (1 in 200) suffering from seropositive rheumatoid
arthritis develop scleritis.
• Other associated collagen disorders are Wegener's granulomatosis,
polyarteritis nodosa {PAN) ,systemic lupuserythematosus (SLE) and
Ankylosing spondylitis.

5. • Gout and thyrotoxicosis have also been reported to be associated with
scleritis.
5
• Some infections, particularly herpes zoster ophthalmicus
chronic staphylococcal
streptococcal infection Will cause Scleritis

6. • like tuberculosis, syphilis, sarcoidosis, leprosy can also cause scleritis
6
• Irradiation, chemical burns,
• Behcet's disease and rosacea are also implicated in the etiology.

7. Is a rare complication of ocular surgery. It occurs within 6 months postoperatively. Exact
mechanism not known, may be precipitation of underlying systemic cause

8. Fibrinoid necrosis
Destruction of collagen
Infiltration by polym orphonuclear cells, lymphocytes,
plasma cells and macrophages.
SCLERITIS

17. It is treated by:
• Topical steroid eye drops
• Systemic indomethacin 75 mg twice a day until inflammation resolves.

18. • Topical steroids
• Oral steroids on heavy doses, tapered slowly.
• Immunosuppressive agents like methotrexate
or cyclophosphamide may be required in nonresponsive cases.
• Sub conjunctival steroids are contraindicated
because they may lead to scleral thinning and
perforation.
• Surgical treatment, in the form of scleral patch graft
may be required to preserve integrity of the globe
in extensive scleral melt and thinning.

19. Most of the time diagnosis is delayed and patients are put on topical and oral
steroids which worsen the infective scleritis.
Treatment includes:
• Antimicrobial therapy, both with topical and oral agents is required in an aggressive
manner.
• Surgical debridement is found useful by debunking the infected scleral tissue and also
facilitating the effect of antibiotics.