Ophthalmology

Unit 9: Red Eye

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11: Scleritis

Aetiology

50% Idiopathic

50% with systemic associations:

  • Herpes zoster ophthalmicus
  • Rheumatoid arthritis
  • Relapsing polychondritis
  • Wegener granulomatosis
  • Polyarteritis nodosa
  • Systemic lupus erythematosus
photo of an eye with scleritis

Source: EyeRounds.org. Contributor: Andrew Doan, MD, PhD, University of Iowa.

Symptoms

  • Gradual onset
  • Severe pain
  • Photophobia
  • Tearing
  • Normal or mildly blurred vision
  • Dull, deep, severe pain that can wake patient at night

Signs

  • Localised or diffuse scleral hyperaemia, tender to palpation
  • Pale areas within red zone can indicate necrotising scleritis
  • Possible corneal + intraocular inflammation

Management

Refer to an ophthalmologist for:

  • Oral NSAID (Froben) or corticosteroid
  • Systemic evaluation by rheumatologist
  • Possible cytotoxic agents