Scleritis

Question 1

What is scleritis?

Answer 1

Transmural inflammation of the sclera

Question 2

Describe the epidemiology of scleritis?

Answer 2

F>M, mean age 40-60 years old

Question 3

What causes scleritis?

Answer 3

In up to 60% of patients, associated with underlying systemic disorder or infection → most commonly rheumatoid arthritis, but also SLE, IBD and gout

Question 4

What are the presenting symptoms/ signs of scleritis?

Answer 4

• Deep, aching, boring eye pain → exacerbated by eye movement and palpation, may radiate to rest of face
• Red Eye
• Photophobia
• Lacrimation (tears)
• Episcleritis (inflammation more superficial) → milderpain/ painless compared to scleritis

Question 5

What investigations are used to diagnose/ monitor scleritis?

Answer 5

1. Phenylephrine Drops → distinguish between scleritis and episcleritis. If eye redness improves after phenylephrine a diagnosis of episcleritis can be made.
2. Ultrasound → detect signs of posterior scleritis
3. Orbital CT/MRI → differentiate between orbital lesions
4. Workup for Systemic Disease → eg. RA, ANA

Question 6

How is scleritis managed?

Answer 6

Urgent referal to an opthalmologist (threat to sight).
1. NSAIDs → 1st line in mild-moderate cases (such as fluriprofen PO 100 mg TDS for mild cases)
2. Systemic Glucocorticoids → if unresponsive to NSAIDs
Corticosteroids such as oral prednisolone or pulsed IV methylprednisolone for severe or necrotising cases
3. Systemic Immunosuppresive Therapy (Azathioprine, Methotrexate) → if unresponsive to steroids