Scleritis

Question 1

What is scleritis?

Answer 1

Scleritis is inflammation of the sclera, the outer layer of connective tissue surrounding the eye - the white part

Question 2

What is episcleritis?

Answer 2

Inflammation of the episclera - the clear layer on top of the white sclera

Question 3

What conditions are associated with scleritis?

Answer 3

Autoimmune diseases
- Rheumatoid arthritis
- SLE
- IBD
- Vasculitis

Question 4

What are the risk factors for scleritis?

Answer 4

Female
Autoimmune disease
Trauma
Ocular surgery
Ocular infection

Question 5

What is the presentation of scleritis?

Answer 5

Red, inflamed sclera
Congested vessels
Severe pain
Pain with eye movement
Photophobia
Excessive tear production
Reduced visual acuity

Question 6

What are the differences between scleritis and episcleritis?

Answer 6

Scleritis
- More severe pain
- Deep inflamed vessels rather than superficial
- Vessels do not blanch to topical phenylephrine
- Vessels are immobile via cotton tipped applicator

Question 7

What investigations are used in the diagnosis of scleritis?

Answer 7

Bloods - FBC, U&E, LFTs, bone profie
ESR and CRP
Autoimmune screen
B scan ultrasonogrpahy of the globe

Question 8

What is the first line management of scleritis?

Answer 8

NSAIDs
Corticosteroids - topical, oral or IV

Question 9

What is the management of refractory scleritis?

Answer 9

DMARDs
Biological agents e.g infliximab
Surgical intervention

Question 10

What is the management of episcleritis?

Answer 10

Usually self-limiting
- Analgesia
- Lubricating eye drops