CDA - Scleritis

Question 1

What are key signs of acute scleritis?

Answer 1

1. Beefy red eye –> nodular/diffuse
2. Deep aching pain radiating to the beow or mastoid
3. Pain that wakes the patient at night
4. History of autoimmune disease (such as rheumatoid arthritic, lupus)
5. Use of bisphosphonates (for osteoporosis) or immunotherpay for cancer

Question 2

How to examine the eye for signs of scleritis?

Answer 2

1. Examine the eye in daylight or incandescent light
2. Examine the lids for rosacea
3. W/ slit lamp use a narrow slit beam to look for scleral vs episcleral involvement
   –> scleral nodule is opaque, episcleral nodule is yellowish/translucent
4. Red free light looking for vascular dropout and looking under the episcleritis
5. Emptying and refilling after compression with a cotton bud - no movement of nodule = scleritis
6. Looking for corneal involvement

Question 3

What signs internally can you examine for scleritis?

Answer 3

1. Flare in the anterior segment ischaemia
2. Secondary uveitis
3. Anterior chamber depth = shallowed if there is choroidal effusion
4. IOP = can be elevated or decreased
5. Subretinal mass
6. Macular star or exudates
7. Optic nerve head swelling