Scleritis and Episcleritis

Question 1

What is Scleritis?

Answer 1

Inflammation (not usually caused by infection) of the full thickness of the sclera.

Question 2

Associations of Scleritis (5).

Answer 2

50% of patients have an associated systemic condition e.g. :-

1. Rheumatoid Arthritis (strongest association).
2. SLE.
3. IBD.
4. Sarcoidosis.
5. Granulomatosis with Polyangiitis.

Question 3

Epidemiology of Scleritis.

Answer 3

Commoner in middle-aged women.

Question 4

Most Severe Type of Scleritis.

Answer 4

Necrotising Scleritis - visual impairment but no pain and can lead to perforation of the sclera.

Question 5

Clinical Features of Scleritis (4).

Answer 5

1. Acute Onset.
2. 50%. of cases are bilateral.
3. Deep Boring Pain.
4. Severely Red Eye.

Question 6

Investigation of Scleritis.

Answer 6

Any patient who presents with red eye with a suspected potentially sight-threatening cause should be referred for same day assessment by an ophthalmologist.

Question 7

Management of Scleritis (4).

Answer 7

1. Further Assessment for an underlying systemic condition.
2. NSAIDs (Topical/Systemic).
3. Steroids (Topical/Systemic).
4. Immunosuppressants (appropriate to the systemic condition e.g. Methotrexate - RA).

Question 8

Definition of Episcleritis.

Answer 8

Benign and self-limiting inflammation (not infection) of the episclera (outermost layer of sclera, just under conjunctiva).

Question 9

Epidemiology of Episcleritis.

Answer 9

Commoner in young-middle aged adults.

Question 10

Differences between SCLERITIS and Episcleritis (4).

Answer 10

1. Severity of Pain (No/Mild).
2. Ophthalmoplegia.
3. Non-Blanching Vessels.
4. Diffuse (unlike Segmental - Lateral) Redness.

Question 11

Clinical Differentiation of Scleritis and Episcleritis (3).

Answer 11

1. Phenylephrine Eye Drops.
2. Blanches conjunctival and episcleral vessels.
3. If redness improves - Episcleritis.

Question 12

Management of Episcleritis (3).

Answer 12

1. No treatment.
2. Simple analgesia.
3. Cold Compresses.