Sclera

Question 1

Scleritis

Answer 1

Significant dull pain | Tearing | Photophobia | Possible pain with eye movement | Possible vision loss

SIGNS
Sectoral or diffuse injection | Blue-violet scleral hue | Tearing | Scleral thinning | Possible nodule
Posterior scleritis may show: Optic nerve edema | Macular edema | Choroidal folds | Retinal detachment | Subretinal granuloma

WORK-UP Thorough history | Slit lamp examination | Dilated fundus exam | B-scan for posterior scleritis (check for T-sign) | Complete blood work-up and physical examination | A laboratory work-up may be extensive

TREATMENT
Oral NSAIDs: Ibuprofen 600 mg tid |
Flurbiprofen 100 mg tid |
Indomethacin 50 mg tid

Oral steroids: Prednisone 60 mg qd with taper to 20 mg qd

Topical antibiotic drops may be used to reduce risk of secondary infection (polytrim 1 gtt qid) | Scleral graft, IV steroids, and/or immunosuppressive agents may be indicated

FOLLOW-UP Every 1-3 days during treatment