DESCRIPTION

• 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

EPIDEMIOLOGY

• Mean age is 54 years (ranges from 12 to 96 years).
• Predominant sex: female > male (1.6:1)

ETIOLOGY AND PATHOPHYSIOLOGY

• 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.

RISK FACTORS

Individuals with autoimmune disorders are most at risk.

COMMONLY ASSOCIATED CONDITIONS

• 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