Anterior necrotizing Scleritis without inflammation (scleromalacia perforans)

Question 1

main association

Answer 1

RA

Question 2

Symptoms

Answer 2

No to minimal symptoms

Question 3

Signs

Answer 3

Necrotic scleral plaques (appears blue-grey) near the limbus without surrounding inflammation. (not many surrounding blood vessels or redness)

Question 4

How rare?

Answer 4

only 4% of scleritis.

Question 5

Other etiologies for blue-grey sclera

Answer 5

Age related scleral thinning. (typically near recti muscle insertions)

Genetic defect in collagen synthesis (Ehler’s Dalos)

Drug toxicity (minocycline)

Axenfeld loop (long ciliary nerve that courses anteriorly through the sclera before looping back to course to the ciliary body)

oculodermal malnocytosis