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Scleritis

Scleritis is the inflammation of the sclera. The most severe type of it is Necrotising Scleritis, which presents with visual impairment w/o pain and can lead to perforation of the sclera (most significant complication).

“Inflammation of the sclera” © Kribz CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Episcleritis is the benign, self-limiting inflammation of the episclera (the outermost layer of the sclera). It's typically less painful than scleritis and managed with analgesia, cold compresses, and safety-netting. 50% of these patients have an associated rheumatological condition e.g. RA, SLE, IBD, Sarcoidosis.

“Episcleritis of eyeball” © Asagan CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Presentation:

  • Severe pain – Worse at night

  • Pain on eye movement as extra-ocular muscles insert into scleral tissue - This won’t be present in episcleritis as the insertion points aren’t affected

  • Photophobia

  • Watery eye

  • O/E - Reduced visual acuity, Abnormal pupil light reflex

    • In episcleritis, the vessels can be moved with a cotton bud, and they blanch when phenylephrine 10% (similar to adrenaline) is applied. Scleral vessels won't respond in this way.


Management - NSAIDS, Steroids, Immunosuppressants




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