Scleritis is inflammation involving the entire thickness of the sclera. It is a severe ocular inflammation, often with ocular complications, which nearly always requires systemic treatment

Aetiology:

• Scleritis often appears in association with other inflammatory diseases such as RA and granulomatosis with polyangitis
• Scleritis may be the first symptom of a connective tissue disease

Epidemiology:

• Scleritis is rare. It occurs more frequently in women and generally in an older age group than patients with episcleritis, with an age range of 40-60 years.

Types:

• Can be anterior (90% of cases) or posterior
• Anterior can be divided into -
  • Diffuse (most common, tends to resolve)
  • Nodular - May progress to necrotising
  • Necrotising (less frequent, extreme pain, marked scleral damage)
• Posterior - Difficult to diagnose, 1/3 of patients also have anterior scleritis

PC

Subacute or gradual onset of Sx:

• Main feature - severe ocular pain and redness
• No discharge other then watering
• May have associated systemic Sx - fever, vomitting, headache
• Posterior scleritis may present with severe Sx but a white eye

On examination:

• Deep scleral vessel engorgement - (Scleral vessels appear darker then episcleral, follow a radial pattern, are immobile and do not blanch)