16. 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
globe d) Presence of associated
anterior uveitis indicative of very severe disease involving
ciliary body
Complications: corneal involvement,cataract,glaucoma.
18. Anterior necrotizing
scleritis without
inflammation
1. Presentation: Asymptomatic
2. Signs: Starts with a yellow necrotic patch
Large areas of uvea become exposed
3. Complications: Perforation rare unless IOP elevated
22. 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
25. 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)
26. 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.
27. Surgical treatment
• Extreme scleral thinning requires reinforcement.
• Corneal marginal ulceration or keratolysis may require corneal grafting .