Scleritis

Scleritis involves inflammation of the full thickness of the sclera. This is more serious than episcleritis. It is not usually caused by infection.

The most severe type of scleritis is called necrotising scleritis. Most patients with necrotising scleritis have visual impairment but may not have pain. It can lead to perforation of the sclera. This is the most significant complication of scleritis.

 

Associated Systemic Conditions

There is an associated systemic condition in around 50% of patients presenting with scleritis. This may be:

  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Inflammatory bowel disease
  • Sarcoidosis
  • Granulomatosis¬†with polyangiitis

Presentation

Scleritis usually presents with an acute onset of symptoms. Around 50% of cases are bilateral.

  • Severe pain
  • Pain with eye movement
  • Photophobia
  • Eye watering
  • Reduced visual acuity
  • Abnormal pupil reaction to light
  • Tenderness to palpation of the eye

Management

NICE Clinical Knowledge Summaries on red eye say patients with potentially sight threatening causes of red eye should be referred for same day assessment by an ophthalmologist.

Management in secondary care involves:

  • Consider an underlying systemic condition
  • NSAIDS (topical / systemic)
  • Steroids (topical / systemic)
  • Immunosuppression appropriate to the underlying systemic condition (e.g. methotrexate in rheumatoid arthritis)

 

Last updated April 2019
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