Scleritis
Scleritis is severe inflammation of the sclera causing deep eye pain, a dark red or violaceous tender eye and possible visual loss; it is an ophthalmic emergency because necrotising or posterior disease can destroy the eye and may reveal systemic autoimmune, vasculitic or infectious disease.
Definition
Scleritis is severe inflammation of the sclera, the dense collagenous outer coat of the eye. It may be anterior or posterior, non-necrotising or necrotising, and can cause corneal, uveal, retinal or optic-nerve complications and permanent visual loss. It may be idiopathic, autoimmune or infectious.
First principles
Deep scleral inflammation causes disproportionate pain
The sclera is a dense, innervated outer coat of the eye. Inflammation causes deep aching or boring pain that can radiate to the brow or jaw, worsen with eye movement and wake the patient. This pattern separates scleritis from the mild surface irritation of episcleritis or conjunctivitis, although painless necrotising disease can occur.
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