- Necrotising scleritis is a dangerous and destructive form of scleritis, however, it is least common.
- It is an inflammatory condition that affects the sclera and is commonly associated with an underlying autoimmune disease, vasculitis or systemic collagen vascular disease.
- Progression of disease causes the sclera to necrose, leaving a white patch of thin sclera surrounded by red, inflamed blood vessels.
- Necrotising scleritis is commonly seen in middle-aged women with rheumatologic disease and is associated with worsening vasculitis.
A 73-year-old female patient presented to the emergency department with a 1-month history of pain in her right eye and was diagnosed with necrotising scleritis. The patient had a history of seropositive erosive rheumatoid arthritis.
The patient’s medical history further revealed that she had stopped immunosuppressive treatment 4 years before and switched to homeopathic treatment Examination showed 20/25 visual acuity in the affected eye. Slit lamp examination showed hyperemia, inflammation and marked scleral thinning associated with exposure of the underlying choroid.
Laboratory examinations showed elevated rheumatoid factor and increased erythrocyte sedimentation rate. Testing for antineutrophil cytoplasmic antibodies was negative. The findings were consistent with the diagnosis of necrotising anterior scleritis associated with inflammation.
The patient was started on intravenous glucocorticoids and cyclophosphamide. The treatment plan included surgical repair with scleral graft and amniotic membrane transplantation. A conjunctival autograft was retrieved from the same eye. The patient was prescribed a tapering course of oral glucocorticoids and oral methotrexate.
Ocular inflammation and pain had resolved at 3-month follow up after surgery. The patient’s vision was preserved.
References
Necrotizing Scleritis https://www.nejm.org/doi/full/10.1056/NEJMicm2004836
