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Ophthalmology and Visual Sciences

Nodular anterior scleritis

Nodular anterior scleritis

Category(ies): Cornea, Uveitis
Contributor: Jesse Vislisel, MD
Photographer: Brice Critser, CRA

Scleritis is a severe, immune-mediated ocular inflammatory condition that is frequently associated with systemic immunologic disease. The condition is classified by location (anterior or posterior) and the appearance of scleral inflammation (diffuse, nodular, or necrotizing).

inflamed scleral vasculature and a prominent scleral nodule inferior to the limbus
This photograph displays dilated, inflamed scleral vasculature and a prominent scleral nodule inferior to the limbus.

Contributor: Elaine M. Binkley, MD; William E. Flanary, MD; H. Culver Boldt, MD
Photographer: Jody Troyer

Nodular anterior scleritis: Anterior scleritis may present in diffuse, nodular, or necrotizing forms. Patients with nodular scleritis present with one or more firm, tender nodules. This image shows nodular thickening of the sclera with typical violaceous hue due to dilated scleral vessels. There is also overlying dilation of the conjunctival and episcleral vessels and mild chemosis. While conjunctival and episcleral involvement are often seen overlying active nodular scleritis, scleral involvement is necessary to make this diagnosis. Scleritis is often associated with underlying systemic autoimmune diseases such as rheumatoid arthritis, granulomatosis with polyangiitis (formerly called Wegener's granulomatosis), spondyloarthritis, or systemic lupus erythematosus. Treatment is with systemic and topical non-steroidal anti-inflammatory drugs, systemic steroids, or systemic immunosuppression. Newer literature suggests that subconjunctival steroids may be effective in non-necrotizing cases.

  1. Generali E, Cantarini L, and Selmi C. 2015. Ocular involvement in systemic autoimmune diseases. Clinical Reviews in Allergy & Immunology. 49(3)263-270.
  2. Krachmer J, Mannis M, Holland E. 2011. Corneal disease in rheumatoid arthritis. Cornea, 3rd edition. 1117-1132.
  3. Sohn E et al. 2011. Long term, multi-center evaluation of subconjunctival injection of triamcinolone for non-necrotizing, non-infectious anterior scleritis. Ophthalmology. 118(10): 1932-1937.

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