Inflammation of the sclera, which in its severe necrotizing or in the posterior type may cause sight-threatening complications such as keratitis, uveitis, angle-closure glaucoma or optic neuropathy. It affects females more commonly than males in the fourth to sixth decades of life. Like episcleritis it has a tendency to recur. It is characterized by pain, which can be severe, redness, tearing and some patients may develop nodules (
nodular scleritis). It is often associated with a systemic disease (e.g. rheumatoid arthritis, Wegener's granulomatosis, polyarteritis nodosa, lupus erythematosus, ankylosing spondylitis, syphilis, herpes zoster). It can involve part of the sclera, e.g.
anterior scleritis (which is the most common, and it is classified as diffuse non-necrotizing or nodular non-necrotizing) or
posterior scleritis. Treatment includes topical and systemic steroids and immunosuppressive drugs for very severe cases.
See acute stromal keratitis;
Brown's superior oblique tendon sheath syndrome.
necrotizing scleritis The most severe form of scleritis, much less common than the other types. About half the patients have one of the following diseases: rheumatoid arthritis, Wegener's granulomatosis, polyarteritis nodosa, systemic lupus erythematosus, or herpes zoster. It is characterized by pain, and white, avascular areas next to damaged areas through which one can see the brown colour of the underlying uveal tissue, and to congested areas of the sclera. In most cases visual acuity is decreased. The necrosis gradually spreads around the globe. Treatment typically consists of topical steroids, immunosuppressive agents and occasionally surgery to repair scleral or corneal perforation.
See keratolysis;
scleromalacia.
scleritis necroticans See scleromalacia.
posterior scleritis Inflammation of the sclera involving the posterior segment of the eye. The condition is often associated with a systemic disease (e.g. rheumatoid arthritis). It is characterized by pain and reduced visual acuity. The severity of the visual impairment depends on the involved tissue and its location. Signs include eyelid oedema, proptosis, limitation of ocular movements and, if anterior scleritis is present, redness. The ocular fundus may present disc swelling, choroidal folds, macular oedema and serous retinal detachment. Treatment consists mainly of systemic steroids and immunosuppressive agents.
See choroidal folds.