Diffuse Scleritis

 

Clinical features:

  • Granulomatous inflammation of the sclera.
  • May present in association with systemic diseases i.e. rheumatoid arthritis, SLE, polyarteritis nodosa, or Wegener's granulomatosis.
  • Symptoms: ocular pain with or without decreased vision.
  • May be self-limiting or progress to necotizing process that may be potentially blinding.
  • May be classified into non-necrotizing or necrotizing anterior scleritis and non-necrotizing or necrotizing posterior scleritis.
  • Non-necrotizing inflammation may be differentiated into nodular and diffuse scleritis.
  • Complications: scleral thinning (especially in the chronic recurrent scleritis), scleromalacia, scleral perforation, sclerosing keratitis, peripheral corneal melting, uveitis, cataract, macula edema, retinal detachment and choroidal granuloma.

Work up:

  • Systemic rheumatology evaluation.
  • Always rule out infection in cases of necrotizing scleritis.
  • Treatment: systemic NSAIDs, systemic or topical corticosteroids, cyclophosphamide, cyclosporin or other immunosuppressive therapies.