Scleritis

Question 1

What is Scleritis?

Answer 1

Granulomatous inflammation of the sclera, causing a thickened area where macrophages can’t remove the inflamed tissue.

Question 2

What are the different types of Scleritis?

Answer 2

• Anterior (diffuse/nodular)
• Posterior
• Necrotizing (with or without inflammation, scleromalacia perforans)

Question 3

What diseases are associated with Scleritis?

Answer 3

• Collagen diseases (rheumatoid arthritis, SLE, ankylosing spondylitis)
• Granulomatous diseases (TB, syphilis, sarcoidosis)
• Infections (herpes simplex/zoster, onchocerciasis)
• Metabolic disorders (gout, Grave’s disease)
• Trauma or previous surgery

Question 4

What are the common signs of Scleritis?

Answer 4

• Reduced visual acuity (VA)
• Deep red scleral vessels
• Blue/black scleral discolouration
• Proptosis
• Macular folds
• Disc oedema
• Exudative retinal detachment
• Extraocular muscle (EOM) restrictions

Question 5

What are the common symptoms of Scleritis?

Answer 5

• Severe pain
• Photophobia
• Visual disturbance (double vision)

Question 6

How is Scleritis associated with autoimmune diseases?

Answer 6

It is linked to autoimmune conditions like rheumatoid arthritis and lupus, which cause collagen or granulomatous inflammation.

Question 7

What is the first step in managing Scleritis?

Answer 7

Emergency (same day) referral and investigation of underlying disease.

Question 8

What investigations are recommended for Scleritis?

Answer 8

• Blood tests
• Chest X-ray
• VDRL test
• B-scan ultrasound (for posterior scleritis)

Question 9

What oral NSAIDs are recommended for Scleritis?

Answer 9

• Ibuprofen
• Flurbiprofen
• Plus lansoprazole/omeprazole if stomach issues are present

Question 10

When are systemic steroids used for Scleritis?

Answer 10

If NSAIDs are contraindicated or ineffective, systemic steroids like prednisolone may be used.

Question 11

Why are topical steroids not effective for Scleritis?

Answer 11

Because Scleritis involves deeper inflammation, systemic treatments are required for effective management.

Question 12

What immunosuppressive agents are used in Scleritis?

Answer 12

• Cyclosporine
• Indomethacin
• Azathioprine
• Methotrexate

Question 13

How does Scleritis affect the retina?

Answer 13

It can cause exudative retinal detachment and macular folds due to inflammation.

Question 14

How does Scleritis cause visual disturbances?

Answer 14

Inflammation can lead to reduced visual acuity and double vision due to extraocular muscle restrictions.

Question 15

How is posterior Scleritis diagnosed?

Answer 15

With a B-scan ultrasound to visualize the inflammation behind the eye.

Question 16

What is the role of immunosuppressive therapy in Scleritis?

Answer 16

It helps control severe inflammation, especially in cases unresponsive to NSAIDs and steroids.

Question 17

What can happen if Scleritis is left untreated?

Answer 17

It can cause permanent vision loss, with 30% of patients losing significant visual acuity within 3 years.

Question 18

Why is Scleritis often painful?

Answer 18

The deep inflammation of the sclera causes severe pain, especially during eye movement.

Question 19

What systemic diseases can lead to Scleritis?

Answer 19

Autoimmune diseases like rheumatoid arthritis, granulomatous diseases like TB, and metabolic disorders like gout.

Question 20

How does Scleritis affect the scleral vessels?

Answer 20

It causes deep red scleral vessels, which can lead to blue/black discolouration in severe cases.