- Scleritis is a painful, inflammatory process of the sclera, part of the eye’s outer coat.
- Categorized into anterior or posterior and 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
- Mean age is 54 years (range 12 to 96).
- Predominant sex: female > male (1.6:1)
Estimated to be 6 cases per 100,000 people in the general population
- Anterior scleritis, about 94% of cases (1)
- Diffuse anterior scleritis, about 75% (most common)
- Remaining 6% have posterior scleritis.
Etiology and Pathophysiology
- Most commonly associated with rheumatoid arthritis
- In about 38% of cases, scleritis is the presenting manifestation of an underlying systemic disorder.
- Necrotizing scleritis has the highest association with systemic disease.
- Other etiologies
- Proposed pathogenesis is dependent on type of scleritis. In necrotizing scleritis, the predominant mechanism is likely due to the activity of matrix metalloproteinases.
- Drug-induced scleritis has been reported in patients on bisphosphonate therapy.
- Surgically induced necrotizing scleritis is exceedingly rare and occurs after multiple surgeries.
Individuals with autoimmune disorders are most at risk.
Commonly Associated Conditions
- Rheumatoid arthritis (most common)
- Sjögren syndrome
- Granulomatosis with polyangiitis
- HLA-B27–associated ankylosing spondylitis
- Systemic lupus erythematosus
- Behçet disease
- Juvenile idiopathic arthritis
- Cogan disease
- Relapsing polychondritis
- Polyarteritis nodosa
- Inflammatory bowel disease
- Herpes zoster, herpes simplex
- HIV, syphilis, Lyme disease, tuberculosis
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Domino, Frank J., et al., editors. "Scleritis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116547/all/Scleritis.
Scleritis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116547/all/Scleritis. Accessed June 1, 2023.
Scleritis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116547/all/Scleritis
Scleritis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 01]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116547/all/Scleritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Scleritis ID - 116547 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116547/all/Scleritis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -