Ophthalmology - Scleritis

Question 1

What is scleritis?

Answer 1

Inflammation of the sclera, the outer layer of connective tissue surrounding most of the eye

Excluding the cornea

Question 2

What is the most severe type of scleritis?

Answer 2

Necrotising scleritis, which can lead to perforation of the sclera.

Question 3

What is the main cause of scleritis?

Answer 3

Most cases are idiopathic or associated with an underlying systemic inflammatory condition

Can sometimes be caused by infection

More common in women

Question 4

Which infections can cause scleritis?

Answer 4

Pseudomonas
Staphylococcus aureus

Question 5

What are two systemic conditions associated with scleritis?

Answer 5

• Rheumatoid arthritis
• Vasculitis, particularly granulomatosis with polyangiitis (wegner’s syndrome)

Question 6

What is a key difference between conditions associated with scleritis and anterior uveitis?

Answer 6

Scleritis
Rheumatoid arthritis
Vasculitis
As the connective tissues is similar to that of joints

Anterior uveitis
Seronegative spondyloarthropathies

Question 7

How does scleritis typically present?

Answer 7

Gradual onset, can be unilateral or bilateral
* Red, inflamed sclera (localised or diffuse)
* Congested vessels
* Severe pain (typically a boring pain)
* Pain with eye movement
* Photophobia
* Epiphora (excessive tear production)
* Reduced visual acuity
* Tenderness to palpation of the eye

Question 8

How is scleritis managed?

Answer 8

Urgent assessment and management by an ophthalmologist

Assessment for underlying systemic condition

Question 9

What treatments may be involved in secondary care for scleritis?

Answer 9

• NSAIDs
• Steroids (topical or systemic)
• Immunosuppression appropriate to the underlying systemic condition (e.g., methotrexate in rheumatoid arthritis)

Antimicrobials only needed for infectious scleritis