Diffuse Scleritis

Clinical Features

Granulomatous inflammation of the sclera.
May present in association with systemic diseases i.e. rheumatoid arthritis, SLE, polyarteritis nodosa, or Wegener's granulomatosis.
Symptoms: ocular pain with or without decreased vision.
May be self-limiting or progress to necotizing process that may be potentially blinding.
May be classified into non-necrotizing or necrotizing anterior scleritis and non-necrotizing or necrotizing posterior scleritis.
Non-necrotizing inflammation may be differentiated into nodular and diffuse scleritis.
Complications: scleral thinning (especially in the chronic recurrent scleritis), scleromalacia, scleral perforation, sclerosing keratitis, peripheral corneal melting, uveitis, cataract, macula edema, retinal detachment and choroidal granuloma.

Systemic rheumatology evaluation
Always rule out infection in cases of necrotizing scleritis
Treatment: systemic NSAIDs, systemic or topical corticosteroids, cyclophosphamide, cyclosporin or other immunosuppressive therapies