Scleritis Flashcards
What is scleritis?
Scleritis involves inflammation of the full thickness of the sclera. This is more serious than episcleritis. It is not usually caused by infection.
Briefly describe necrotising scleritis
The most severe type of scleritis is called necrotising scleritis. Most patients with necrotising scleritis have visual impairment but may not have pain. It can lead to perforation of the sclera. This is the most significant complication of scleritis.
What conditions are associated with scleritis?
There is an associated systemic condition in around 50% of patients presenting with scleritis. This may be:
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Inflammatory bowel disease
- Sarcoidosis
- Granulomatosis with polyangiitis
What are the clinical features of scleritis?
Scleritis usually presents with an acute onset of symptoms. Around 50% of cases are bilateral.
- Severe pain
- Pain with eye movement
- Photophobia
- Eye watering
- Reduced visual acuity
- Abnormal pupil reaction to light
- Tenderness to palpation of the eye
Briefly describe the management of scleritis
Management in secondary care involves:
- Consider an underlying systemic condition
- NSAIDS (topical / systemic)
- Steroids (topical / systemic)
- Immunosuppression appropriate to the underlying systemic condition (e.g. methotrexate in rheumatoid arthritis)
What is the NICE guidance of a patient presenting with a red eye?
NICE Clinical Knowledge Summaries on red eye say patients with potentially sight threatening causes of red eye should be referred for same day assessment by an ophthalmologist.
Give differentials for a painless red eye
- Conjunctivitis
- Episcleritis
- Subconjunctival Haemorrhage
Give differentials for a painful red eye
- Glaucoma
- Anterior uveitis
- Scleritis
- Corneal abrasions or ulceration
- Keratitis
- Foreign body
- Traumatic or chemical injury
