Opthal: Scleritis: Free MSRA Podcast

🔴Scleritis – TheSight-Threatening Red Eye You Can’t Miss 🔴Welcome to anotherDeep Dive – today we’re exploring scleritis,a rare but serious inflammatory eye condition that could be your clue tosystemic autoimmune disease.🧠 Why it matters?Though uncommon, scleritis can lead to vision loss, ocular perforation,and may even be the first sign of systemicvasculitis. Early recognition and multi-specialist management areessential. 🔍Definition:Inflammation of the sclera (the white outer coat of the eye), oftenautoimmune in origin. It's deeper, more painful, and far more dangerous thanepiscleritis. ⚠️Types:Anterior Scleritis (90%)  • Diffuse – most common, moderate severity   • Nodular – recurrent, may progress   • Necrotising – severe, painful, sight-threatening (emergency!)Posterior Scleritis (10%) – harder to detect, can mimic orbital disease📌Mnemonic: D-N-N = Diffuse, Nodular, Necrotising 🧬Causes & RiskFactors:Autoimmune: RA, SLE, GPA (Wegener’s), polyarteritis nodosaInfectious: TB, syphilis, herpesOthers: Post-surgical, trauma, bisphosphonatesStrongly associated with RA – most common underlying cause📌Mnemonic: SCLERA –Systemic diseaseConnective tissue (RA/SLE)Local infection/traumaEpisodes (recurrence)Rheumatological linksAutoimmune disorders 🧠Symptoms – thinkSPRINT:Severe pain (boring, worse at night)PhotophobiaRedness (deep, violaceous hue)Impaired visionNocturnal worseningTearing (lacrimation) 🧪Investigations:Slit lamp examVisual acuity + IOPBloods: ESR, CRP, FBC, RF, ANA, ANCASyphilis screen, TB testImaging: B-scan for posterior scleritis, chest X-ray, MRI if vasculitis suspected🧬 Always screen for systemic vasculitis or autoimmune disease. 💊Management (UK/NICEapproach):Diffuse/nodular:  • Start with oral NSAIDs (e.g. ibuprofen)   • Step up to oral steroids (e.g. prednisolone)   • Add DMARDs (methotrexate, azathioprine) if refractoryNecrotising:  • Urgent systemic steroids + immunosuppressants  • Often requires cyclophosphamide  • Avoid periocular steroid injections – risk of perforationPosterior:  • Treat like anterior if vision-threatening   • Biologics (e.g. infliximab) for resistant casesAlways treat underlying disease + urgent ophthalmology referral 🧿Complications:Vision lossScleral thinning/perforationGlaucoma, cataracts, uveitis, retinal detachmentPhthisis bulbi (shrunken, non-functioning eye) 📈Epidemiology:Rare: ~3.4 per 100,000 per yearMore common in women and RA patients 🎯Key MSRA Points:Differentiate from episcleritis (mild, non-threatening)Associated with RA – always check for systemic autoimmune diseaseUrgent treatment prevents vision lossRecognise red flag: necrotising scleritis = emergency 📚Useful Resources• Revision Notes → https://www.passthemsra.com/topic/scleritis-revision-notes/• Flashcards → https://www.passthemsra.com/topic/scleritis-flashcards/• Accordion Q&A→ https://www.passthemsra.com/topic/scleritis-accordion-qa-notes/• Rapid Quiz → https://www.passthemsra.com/topic/scleritis-rapid-quiz/• Scleritis MCQ → https://www.passthemsra.com/quizzes/scleritis/ 🔑Final Thought:That deep red eyewith boring pain might not just be local – it could be whispering systemicautoimmune disease. Don’t miss it.#MSRA #Scleritis#Ophthalmology #MSRARevision #AutoimmuneDisease #PassTheMSRA #FreeMSRA #RedEye#VisionLoss