This document discusses scleritis, an inflammation of the sclera. It defines scleritis and notes it is less common than episcleritis. Scleritis can be classified as anterior or posterior, with anterior scleritis subdivided into non-necrotizing diffuse/nodular or necrotizing forms with or without inflammation. Associated systemic diseases are common in 45% of patients. Signs, symptoms, investigations, and treatment are described depending on the classification of scleritis. Surgical treatment may be needed for extreme scleral thinning or corneal complications.

2. SCLERITIS
Dr.Fuad A K Niazi,
Assistant Professor,
Rawalpindi medical college,
Department of Ophthalmology,
Holy Family Hospital.

3. Scleritis

4. OBJECTIVES
• Definition
• Incidence
• Classification
• Signs & Symptoms.
• Specific investigations.
• Treatment

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

6. Scleritis

7. Episcleritis

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

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

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

11. 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

12. CLINICAL FEATURES

13. 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

14. Anterior diffuse scleritis

15. Anterior nodular scleritis

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.

17. Anterior necrotizing scleritis with
inflammation

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

19. Anterior necrotizing scleritis without
inflammation(scleromalacia perforans)

20. 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

21. Posterior scleritis

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

23. Choroidal folds over macula

24. B-scan

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 .