Surgically Induced Necrotizing Scleritis

Abstract

Scleritis (or inflammation of the sclera) is a specific ophthalmic entity. Classical scleritis manifests as a painful, severe, and often progressive disease that often involves the episcleral tissues, cornea, and underlying uvea. The diagnosis of scleritis is clinical and usually straightforward. However, the treatment of scleritis requires a tailored approach, as up to 50% of patients may have an underlying systemic disorder that needs to be diagnosed and treated systemically in order to resolve the ophthalmic disease and limit ophthalmic morbidity and loss of vision.

Surgically induced necrotizing scleritis (SINS) is the onset of scleral inflammation, and often necrosis, which is triggered by a surgical event in the eye of the patient and has been reported following almost all commonly performed ocular surgeries. Since a majority of patients of SINS do not give a prior history of systemic autoimmune or collagen vascular disease, these patients need to be thoroughly investigated. More than 75% of patients with SINS have been ultimately found to be suffering from a systemic autoimmune vasculitic disease. Treatment with topical corticosteroids is insufficient to halt the progressive disease, and systemic steroids and immunosuppressive agents, often combined with surgical intervention, are required to halt the scleral necrosis and prevent the devastating sequelae of SINS.