Scleritis—Infectious Versus Inflammatory

Abstract

Scleritis refers to a heterogeneous group of diseases characterized by a severe painful inflammatory process of the sclera, that may also involve the cornea, adjacent episclera, and underlying uveal tract. It is associated with significant ophthalmic and systemic morbidity. Scleritis sometimes occurs in an isolated fashion, without evidence of inflammation in other organs. However, in up to 50% of patients, scleritis is associated with an underlying systemic illness such as rheumatoid arthritis or granulomatosis with polyangiitis. Infection is an important but rare cause of scleritis, occurring in about 5–10% of all cases. Due to the similarity of its presentation, infectious scleritis is often initially managed as autoimmune, potentially worsening its outcome. Careful clinical history taking (including history of ocular surgery), detailed ocular examination, appropriate investigation for ocular disease with or without underlying systemic disease, and timely intervention has improved the long-term outcome for patients with this disease.