Scleritis

Background

Potentially blinding disorder
Sclera fuses with dura mater and arachnoid sheath of the opic nerve
- Reason why optic nerve edema and visual compromise are common complications
50% of cases associated with an underlying disorder:
- Inflammatory bowel disease
- Rheumatoid arthritis
- Granulomatosis with polyangiitis (Wegners)

Clinical Features

Non-mobile inflammation of entire scleral thickness

Essential sign is scleral edema, usually accompanied by violaceous discoloration of the globe
Intense ocular pain that radiates to the face
Pain with EOM (extraocular muscles insert into the sclera)
Photophobia
Globe tenderness to palpation
Episcleral vessel dilation

Posterior Scleritis

Posterior to the insertion of the extraocular muscles
Physical exam often benign
- Inflammation may sometimes be seen at the extremes of gaze
Patient complains of pain, pain upon EOM
Involvement of the optic nerve and retina is common
- Retinal detachment, optic disc edema

Complications

Cornea (peripheral ulcerative keratitis → irreversible loss of vision)
Uveal tract (anterior uveitis seen in 40% - spillover of inflammation from the sclera)
Posterior segment (retinal detachment, optic disc edema)

DifferentialDiagnosis

Unilateral red eye

^Emergent diagnoses

^^Critical diagnoses

Evaluation

Labs (to assess possible associated disease)
- CBC
- Chemistry
- Urinalysis (evaluate for glomerulonephritis)
- ESR, CRP

Imaging

Ultrasound and CT can show thickening of the sclera

Management

Systemic therapy with NSAIDs, glucocorticoids, or other immunosuppressive drugs
NSAIDs
- Indomethacin 25-75mg PO TID

Disposition

Urgent ophtho consult

See Also

Red eye

References

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