What is the diagnostic approach for a patient with scleritis?

From the Research

Diagnostic Approach for Scleritis

The diagnostic approach for a patient with scleritis involves a combination of meticulous history taking, detailed ocular examination, and a targeted array of investigations to identify any underlying systemic disease 1. The diagnosis of scleritis is essentially clinical, and eye pain or tenderness should raise concern for scleritis 2.

Key Considerations

• A thorough medical history is crucial to identify any associated systemic rheumatological disease 1, 3
• A detailed ocular examination, including slit lamp examination, is necessary to differentiate between episcleritis and scleritis 4
• Investigations, such as bloodwork, may be helpful to diagnose associated systemic rheumatological disease 2
• Imaging studies, such as ultrasound or MRI, may be necessary to evaluate the extent of scleral involvement 1

Differential Diagnosis

• Episcleritis: a benign and self-limiting disease that can be differentiated from scleritis based on clinical presentation and slit lamp examination 2, 4
• Infectious scleritis: a rare and severe ocular disorder that requires prompt diagnosis and treatment 5
• Other systemic diseases, such as rheumatoid arthritis, granulomatosis with polyangiitis, and vasculitis, can be associated with scleritis and should be considered in the differential diagnosis 1, 3

Diagnostic Challenges

• Posterior scleritis can be difficult to diagnose due to its subtle clinical signs and protean manifestations 1
• Infectious scleritis can be challenging to differentiate from noninfectious scleritis, and a high index of suspicion is necessary to make an accurate diagnosis 5