scleritis

Question 1

what is scleritis?

Answer 1

-inflammation of the full thickness of the sclera

Question 2

what is more serious, scleritis or episcleritis?

Answer 2

scleritis

Question 3

which part of the eye is the sclera?

Answer 3

-white part

Question 4

what is the most severe type of scleritis?

Answer 4

-necrotising scleritis

Question 5

what usually causes scleritis?

Answer 5

-may be underlying autoimmune condition

HLA B27
SLE

Question 6

how does scleritis present?

Answer 6

• usually acute onset
• 50% 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

Violaceous hue (violet/blue)
-Injection of deep vascular plexus

Question 7

what colour may the eye go if a patient has scleritis?

Answer 7

• very red

- may have a violaceous hue (violet/blue)

Question 8

what is the management for scleritis?

Answer 8

-same day assessment by an opthamologist

• consider underlying systemic condition
• NSAIDs (topical/systemic)
• steroids (topical/systemic)
• immunosuppression if appropriate (e.g. methotrexate for RA)

Question 9

what is the episclera?

Answer 9

the thin layer of tissue that lies between the conjunctiva and the connective tissue layer that forms the white of the eye (sclera)

Question 10

who does episcleritis commonly affect?

Answer 10

• young and middle aged adults

- often associated with RA and IBD

Question 11

how does episcleritis present?

Answer 11

• usually presents with acute onset unilateral symptoms
• typically not painful but there can be mild pain
• segmental redness (rather than diffuse)
• foreign body sensation
• dilated episceral vessels
• watering eye
• no discharge

Question 12

what is the management of scleritis?

Answer 12

• episcleritis is usually self limiting and will recover in 1-4 weeks
• in mild cases no treatment is necessary, lubricating eye drops can help symptoms
• simple analgesia, cold compression and safety net advice are appropriate