Scleritis

Definition/diagnostic criteria Scleritis is a rare, severe inflammation of the sclera (the white part of the eyeball). It is a potentially sight-threatening condition and can be bilateral in about 50% of cases​​.

Epidemiology

• Incidence: Approximately 3.4 per 100,000 per annum.
• Age group: Predominantly affects individuals in the middle age group (40-60 years).
• Gender prevalence: More common in females, with a male to female ratio of 2:3.
• Associated conditions: Around 30-40% of cases are linked with autoimmune diseases​​.

Diagnosis
Clinical features:

• Symptoms: Include moderate or severe eye pain, which can extend to the brow or jaw, sleep disturbance, tenderness of the globe, photophobia, epiphora (watery eyes) and visual loss.
• Types: Can involve the anterior or posterior sclera, or both.
  – Anterior scleritis accounts for 90% of cases and is subdivided into non-necrotising (most common) and necrotising forms.
  – Posterior scleritis is less common but can present with more severe symptoms​​​​.

Investigations: Investigations for systemic associations and imaging to investigate posterior segment involvement are crucial for a comprehensive diagnosis. The type of scleritis (e.g., necrotising, non-necrotising) guides the approach to further investigations​​.

Treatment

• Initial management: Systemic analgesia is recommended for pain management​​.
• Referral: Necrotising anterior scleritis and posterior scleritis require emergency referral, while non-necrotising anterior scleritis calls for an urgent referral to an ophthalmologist.
• Ophthalmologist management: May include systemic NSAIDs, topical steroids, systemic immunosuppression (corticosteroids, other immunosuppressant drugs, biologics like TNF alpha inhibitors), and imaging for posterior segment involvement​​.

Prognosis The prognosis of scleritis varies depending on the type and severity. Necrotising scleritis, particularly, can lead to significant visual impairment​​.