Pathophysiology
Scleritis is the inflammation of the full thickness of the sclera, not just the episcleral layer (as seen in episcleritis). As a result it is more serious than episcleritis.
It is not typically due to infection. It is usually associated with systemic conditions (about 50%):
Conditions associated with scleritis are:
- Rheumatoid arthritis
- SLE
- IBD
- Sarcoidosis - granulomatous inflammatory condition all over the body, commonly affecting lungs, liver, eyes.
- Granulomatosis with polyangiitis - it is a form of vasculitis causing inflammation of the vessels in the nose, sinuses, throat, lungs and kidneys.
😷 Presentation
- Severe eye pain - especially with eye movement and on palpation. Pain often wakes the patient up at night
- Red eye
- Photophobia
- Watering eye
- Reduced visual acuity
- Abnormal reaction to light
- Immobile scleral vessels
Topical phenylephrine does not blanch the eye as it affects both the episcleral and scleral vessels.
🧰 Management
🏆 It is an ophthalmic emergency and requires urgent referral for systemic immunosuppression.
Medical management:
- Analgesia
- NSAIDS topically or systemically.
- Steroids also topically or systemically.
- Immunosuppression - depends on the underlying systemic condition.
🚨 Complications
- Necrotising scleritis
- Presents with visual impairment but they may have no pain.
- The can lead to perforation of the sclera.
- If it goes around the back of the globe, it can affect the optic nerve and macula region which may lead to vision loss.
