Scleritis: Anterior

Scleritis: Anterior - Fiery Eye Facts

• Severe, boring ocular pain, radiates (jaw/temple); deep violaceous hue.
• Anterior Scleritis (~90% of cases):
  • Diffuse: Widespread inflammation; most common type.
  • Nodular: Firm, tender, immobile scleral nodule.
  • Necrotizing:
    • With inflammation: Most severe; extreme pain, high vision loss risk.
    • Without inflammation (Scleromalacia Perforans): Painless; typically in RA.
• Photophobia, lacrimation. Systemic disease association in ~50% (e.g., RA, GPA).

⭐ Scleromalacia perforans: painless necrotizing scleritis in elderly RA patients; risk of globe perforation.

Scleritis: Anterior - Systemic Triggers

• Often linked to systemic disease (approx. 50% of cases).
• Connective Tissue Diseases (CTDs): Most frequent cause.
  • Rheumatoid Arthritis (RA): Most common CTD.
  • Granulomatosis with Polyangiitis (GPA).
  • Relapsing Polychondritis.
  • Systemic Lupus Erythematosus (SLE).
  • Inflammatory Bowel Disease (IBD).
• Infections:
  • Tuberculosis, Syphilis, Herpes Zoster.
• Other Systemic Conditions:
  • Sarcoidosis, Gout.

⭐ Rheumatoid Arthritis is the most common systemic disease associated with scleritis, particularly in women.

Scleritis: Anterior - Painful Red Alert

• Severe, boring pain: Radiates (jaw, temple), worse at night, ↑ with eye movement.
• Redness: Deep, violaceous hue; non-blanching with phenylephrine (2.5%).
• Photophobia, lacrimation, ↓ vision possible.
• Types:
  • Diffuse: Most common, widespread inflammation.
  • Nodular: Immobile, tender, erythematous nodule.
  • Necrotizing: Most severe; intense pain, risk of perforation.
    • With inflammation: Often underlying systemic vasculitis.
    • Without inflammation (Scleromalacia Perforans): Often painless, typically in Rheumatoid Arthritis (RA).
• Systemic association (≈50%): RA, Granulomatosis with Polyangiitis (GPA), Inflammatory Bowel Disease (IBD).

⭐ Necrotizing scleritis carries the worst prognosis, with the highest risk of scleral thinning and globe perforation, especially if associated with systemic vasculitis or scleromalacia perforans in RA patients.

Scleritis: Anterior - Spotting the Sore

• Severe, boring pain (worse at night, radiates); photophobia; deep violaceous redness.
• Types:
  • Diffuse: Most common; widespread inflammation.
  • Nodular: Immobile, tender, localized inflamed nodule.
  • Necrotizing: Most severe; avascular areas; high perforation risk.
• Systemic disease link (~50%): RA, GPA, SLE.
• Phenylephrine 10% test: Deep scleral vessels DON'T blanch (vs. episcleritis).
• Workup: ESR, CRP, ANA, RF, ANCA. B-scan for posterior extension. ⭐ > Necrotizing scleritis carries the gravest prognosis and is often linked to systemic vasculitis.
• Complications: ↓VA, sclerosing keratitis, uveitis, glaucoma.

Scleritis: Anterior - Dousing the Flames

• Goal: Control inflammation, relieve pain, prevent complications & vision loss.
• Management Strategy: Stepped approach based on severity & type.

• Complications: ↓ Vision, keratitis, uveitis, glaucoma, cataract, scleral thinning/perforation.

⭐ Approximately 50% of scleritis cases are associated with an underlying systemic autoimmune disease (e.g., RA, GPA).

High‑Yield Points - ⚡ Biggest Takeaways

• Characterized by severe, boring ocular pain that radiates and worsens at night.
• Frequently linked to systemic autoimmune conditions (e.g., RA, GPA).
• Shows a distinctive deep, violaceous or bluish-red scleral hue.
• Key diagnostic sign: Scleral vessels do not blanch with phenylephrine.
• Necrotizing scleritis is the most destructive form, with perforation risk.
• Scleromalacia perforans is a painless necrotizing type in RA.
• Management necessitates systemic treatment (NSAIDs, steroids, immunosuppressants).