Necrotizing scleritis can be treated medically; communication with patients is key.
This article was reviewed by Victor L. Perez, MD
Corneal and ocular inflammation is just the tip of the proverbial iceberg, according to Victor L. Perez, MD, who noted that he views those as indicative of deeper common problems, i.e., autoimmune or systemic disorders and infections.
Dr. Perez is Distinguished Professor of Ophthalmology, Stephen and Frances Foster Endowed Chairman, and director of the Foster Center for Ocular Immunology, Duke Eye Center University School of Medicine, Durham, NC.
Dr. Perez described the protocol he abides by when confronted with a patient with a scleral melt.
First, in contrast to many physicians, Dr. Perez said he steps away from the slit-lamp and talks to the patient.
“The clinical history is important,” he said. “I review the bodily systems and medications and perform an external examination, which is crucial for diagnosing all possible diseases that can be associated with the scleral melt.”
Dr. Perez also pointed out that a full ophthalmic examination should include everything. He noted that physicians should use their pattern recognition skills.
“We are very good at evaluating the eye and recognizing presentations that can help us with the differential diagnosis,” he said.
Some of those possibilities are mild necrotizing scleritis, severe scleral melt, infectious scleritis, and scleromalacia, which is not an active form of scleritis that rarely needs patching.
Know your location
Dr. Perez then advises physicians to be aware of diseases that are common in their locations, because this knowledge will help establish a diagnosis.
He provided an example based on his Boston-based training where most of the etiologies of necrotizing scleritis, including 57%, that were associated with an autoimmune disease or connective-tissue disorder.
This included systemic vasculitis disease in 48%, infection disease in 7%, and rosacea, atopy, or foreign body, in 2%.
A change of location to Bascom Palmer Eye Institute in Miami showed a different local profile, in which the most common presentation was infectious scleritis. In North Carolina, Dr. Perez said he sees several causes of necrotizing scleritis.