Scleritis

SCLERITIS


SCLERITIS

  • Scleritis is an uncommon disorder.
  • Characterised by cellular infiltration, destrucyion of collagen & vascular remodelling.
  • Bilateral disease.
  • Occurs most frequently in women.
  • Rheumatoid arthritis is the most common association.
  • Other important causes are PAN, SLE, Ankylosing, Wegener’s granulomatosis, Dermatomyositis, Reiter’s syndrome, Non-specific arteritis, Polychondritis & Gout.
CLASSIFICATION
I ANTERIOR SCLERITIS (98%)

1. Non-necrotising scleritis (85%)

  • Diffuse-  Diffuse scleritis is widespread inflammation of the sclera, and the most common type.
  • Nodular- Nodular scleritis is characterized by a localized area of inflammation where a distinct nodule can be seen. 

2. Necrotising scleritis (13%)

  • With inflammation- frequently associated with collagen vascular disorders causing destruction of the sclera. 
  • Without inflammation (Scleromalacia perforans)–  very rare form of scleritis presenting with no symptoms.

II. POSTERIOR SCLERITIS (2%)

  • Posterior scleritis can also be nodular or diffuse and necrotizing, and involves the sclera posterior to the insertion of the rectus muscles.

CLINICAL FEATURES

  • Patients complain of moderate to severe pain which is deep & boring in character.
  • Ocular pain radiates to the jaw & temple.
  • Associated with localised or diffuse redness, mild to severe photophobia & lacrimation.
  • Ocassionally occurs diminution of vision.

COMPLICATIONS

  • Complications are common in necrotising scleritis & include sclerosing keratitis, keratolysis, complicated cataract, Uveitis & seconday glaucoma.
  • Scleritis may also cause retinal detachment & macular edema.
  • These are due to spread of inflammation from sclera into the uveal tract.

Exam Important

  • Most common type of scleritis is Non-necrotizing.
  • Scleritis is most commonly associated with Rheumatoid arthritis.
  • The cause of scleritis is Collagen vascular disease.
  • Complications of necrotising scleritis include sclerosing keratitis, keratolysis, complicated cataract, Uveitis & seconday glaucoma.
  • Scleritis may cause retinal detachment & macular edema.
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