Anterior Segment
Scleritis
Also known as: scleritis, anterior scleritis, posterior scleritis, nodular scleritis, necrotising scleritis, scleromalacia perforans, diffuse scleritis, scleral inflammation
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Inflammation of the sclera itself. Classified as anterior (diffuse, nodular, necrotising) or posterior. Associated with systemic autoimmune disease in up to 50% of cases. Can cause sight loss from scleral thinning, corneal melt (PUK), or posterior involvement. Always requires systemic investigation and specialist management.
Recognition
Symptoms: what patients report
- Severe boring or aching pain — a characteristic deep, severe pain that may radiate to the brow, temple, jaw, or be woken from sleep.
- Redness — typically violaceous (purple-red) rather than bright red.
- Significant photophobia.
- Lacrimation.
- Reduced visual acuity or visual disturbance can occur, especially in posterior scleritis or complicated anterior disease.
- Systemic symptoms: arthralgia, joint swelling, skin rash, respiratory symptoms (systemic vasculitis).
- Pain is markedly worse on eye movement (especially posterior scleritis).
Signs: what the examination shows
- Deep violaceous (blue-red or purple-red) scleral injection — does not blanch with phenylephrine 2.5%.
- Scleral oedema — the scleral surface appears raised and oedematous.
- Scleral nodule (nodular scleritis) — firm, tender, fixed to sclera (unlike episcleral nodule which is mobile).
- Necrotising scleritis: avascular necrotic patch, scleral thinning, visible uveal tissue through thin sclera.
- Scleromalacia perforans: painless progressive scleral thinning in RA (no active inflammation).
- Posterior scleritis: choroidal detachment, exudative retinal detachment, disc oedema, and T-sign on B-scan ultrasound.
- Peripheral ulcerative keratitis (PUK): peripheral corneal thinning and infiltrate in adjacent quadrant.
What OptoGuide™ covers for scleritis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Scleritis — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Peripheral Ulcerative Keratitis: Pathogenesis, Diagnosis, and Multimodal Management. Guerrero-Acosta JC, Ortiz-Morales G, Vera-Duarte GR, et al. Journal of Clinical Medicine. 2026;15(3):1264.
- Giant cell arteritis: ophthalmic manifestations of a systemic disease. De Smit E, O'Sullivan E, Mackey DA, Hewitt AW. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinisc
- Case 14-2020: A 37-Year-Old Man with Joint Pain and Eye Redness. Sobrin L, Stone JH, Huang AJ, Niles JL, Nazarian RM. The New England Journal of Medicine. 2020;382(18):1750-1758.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.