c -- necrotizing anterior scleritis
The clinical photos show bilateral injection of scleral and deep episcleral vessels as well as areas of thinning with increased visibility of underlying uveal tissue. Laboratory tests revealed erythrocyte sedimentation rate (ESR) – 84 mm in the first hour, cANCA +ve. Chest X-ray showed pulmonary infiltrates. A diagnosis of Wegener’s granulomatosis was made.
Scleritis occurs more commonly in females than in males with a peak incidence in the fourth to sixth decades. It is bilateral in 50% of cases. This clinically presents as severe, deep boring eye pain which may radiate to the ipsilateral side of the head or face. Nearly 50% of patients with scleritis have an associated systemic disease (rheumatoid arthritis, Wegener’s granulomatosis, relapsing polychondroitis, Reiter’s syndrome, systemic lupus eryathematosis). It can be classified as follows:
- Anterior scleritis
- Diffuse anterior
- Nodular anterior
- With inflammation
- Without inflammation (scleromalacia perforans)
- Posterior scleritis
It can be associated with corneal changes (peripheral keratitis, limbal guttering, keratolysis), glaucoma, uveitis and cataract. Treatment includes oral nonsteroidal anti-inflammatory drugs (NSAIDS), corticosteroids, and immunosuppressives.