Questionnaire/history:

Gradual onset of moderate or severe pain, which is exacerbated by eye movement?

May disturb sleep?

Tenderness of globe?

Photophobia?

Watering eye (Epiphora)?

Visual loss?

Past medical history (eg systemic inflammatory disease (eg rheumatoid arthritis, granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), SLE, systemic lupus erythematosus, polyarteritis nodosa, IBS, syphilis, sarcoidosis, TB)?

History of previous episodes?

Current medication?

Drug allergies?

Examination:

Anterior scleritis (90% of cases):

(a) Non-necrotising (75% of cases):

Usually unilateral?

Hyperaemia of superficial and deep episcleral vessels?

Anterior uveitis may be present?

Tenderness of globe?

When inflammation resolved, choroidal pigment may show through thinned sclera as a blue/black colouration?

Diffuse (approximately 60%)?

Nodular (scleral nodule cannot be moved over underlying tissue) (approximately 40%)?

(b) Necrotising (15% of cases) (most severe form which may occur in the absence of pain, 75% will eventually have visual impairment)?

Avascular patches leading to scleral melting with ectasia and choroidal herniation?

Posterior scleritis (10% of cases):

Involves sclera posterior to the ora serrata, eye may be white?

Ophthalmoscopy may show exudative retinal detachment, macular oedema, optic disc oedema, but may also show no abnormality?

Management:

Advised ibuprofen

Referred to eye casualty

Resource(s):

The College of Optometrists: Scleritis EyeWiki: Scleritis

Information for patient/carer(s):

Patient UK: Episcleritis and Scleritis