SYMPTOMS Significant dull pain | Tearing | Photophobia | Possible pain with eye movement | Possible vision loss
Sectoral or diffuse injection | Blue-violet scleral hue | Tearing | Scleral thinning | Possible nodule
Posterior scleritis may show: Optic nerve edema | Macular edema | Choroidal folds | Retinal detachment | Subretinal granuloma
WORK-UP Thorough history | Slit lamp examination | Dilated fundus exam | B-scan for posterior scleritis (check for T-sign) | Complete blood work-up and physical examination | A laboratory work-up may be extensive
Oral NSAIDs: Ibuprofen 600 mg tid | Flurbiprofen 100 mg tid | Indomethacin 50 mg tid
Oral steroids: Prednisone 60 mg qd with taper to 20 mg qd
Topical antibiotic drops may be used to reduce risk of secondary infection (polytrim 1 gtt qid) | Scleral graft, IV steroids, and/or immunosuppressive agents may be indicated
FOLLOW-UP Every 1-3 days during treatment
ADDITIONAL LAB | TESTS B-scan | Complete lab work-up | Physical exam
ETIOLOGY High association (~50%) with a variety of underlying systemic diseases
DIFFERENTIAL DX Episcleritis | Vogt-Koyanagi-Harada disease | Idiopathic orbital inflammatory syndrome
NOTES Scleromalacia perforans may present with minimal pain | Differentiate episcleritis from scleritis with the blanch test using 2.5% phenylephrine