Scleritis

BASICS

Scleritis is a painful, inflammatory process of the sclera, below the conjunctiva and episclera.
- Categorized by location (anterior or posterior) and subtype (diffuse, nodular, or necrotizing)
- Commonly associated with systemic disorders
- Potentially vision threatening
In contrast, episcleritis is a self-limited inflammation of the superficial episclera with only mild discomfort.
System(s) affected: ocular

Estimated to be 6 cases per 100,000 people in the general population (1)[C]

Anterior scleritis, about 94% of cases (2)[B]
- Diffuse anterior scleritis, about 75% (most common)
Remaining 6% have posterior scleritis.

Frequently associated with a systemic illness (2)[B]
- Most commonly rheumatoid arthritis
- In about 38% of cases, scleritis is the presenting manifestation of an underlying systemic disorder.
Other etiologies
- Drug-induced scleritis has been reported in patients on bisphosphonate therapy.
- Surgically induced necrotizing scleritis is exceedingly rare and occurs after multiple surgeries.
- Infectious scleritis may be viral (HSV, HIV) but occurs most commonly after surgical trauma, and Pseudomonas aeruginosa in poorly controlled diabetic patients is the most common causative organism.

Individuals with autoimmune disorders are most at risk.

Autoimmune disorders
- Rheumatoid arthritis (most common)
- Sjögren syndrome
- Systemic lupus erythematosus
- Sarcoidosis
Vasculitides
- Granulomatosis with polyangiitis
- Polyarteritis nodosa
- Behçet disease
Inflammatory bowel disease
Herpes zoster, herpes simplex
HIV, syphilis, Lyme disease, tuberculosis

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