Necrotizing Anterior Scleritis
Necrotizing scleritis is the most severe form of scleritis and is associated with the greatest potential of ocular complications leading to visual loss. Patients often present with intense pain that radiates to the forehead, the jaw, and the sinuses. Examination reveals white, avascular areas of sclera and conjunctiva, with surrounding scleral edema and congestion. Uveal tissue may be seen as the overlying sclera becomes thin and translucent. Necrotizing scleritis is commonly associated with systemic connective tissue or vasculitic diseases, some of them potentially lethal. Although uncommonly, necrotizing scleritis may be the result of an infectious process that destroys the sclera either through direct microbial damage or through an autoimmune reaction.