Optical coherence tomography in the diagnosis of scleritis and episcleritis

Purpose To describe the optical coherence tomography (OCT) findings in eyes with active anterior scleritis and compare the findings to those with episcleritis and normal controls. Design Prospective evaluation of a diagnostic test. Methods We included a total of 30 eyes of 30 patients with unilateral anterior scleral or episcleral inflammation. The contralateral 30 eyes with no active ocular disease served as controls. OCT was performed over the anterior sclera in the inflamed area on all cases. The OCT images were analyzed to determine the thickness of the sclera and the presence or absence of scleral hyporeflective areas representing intrascleral edema. Results There were 17 male and 13 female patients. The mean age was 43 years with an age range of 21-77 years. Eighteen patients had anterior scleritis and 12 patients had episcleritis. The mean transconjunctival scleral thickness was 747 μm (SD ± 68.97) with a range of 616-877 μm in normal eyes, 882 μm (SD ± 87.35) with a range of 773-1089 μm in patients with scleritis, and 825 μm (SD ± 85.57) with a range of 718-949 μm in patients with episcleritis. Conclusions Patients with active anterior scleritis showed increased thickness of the sclera and presence of intrascleral hyporeflective areas of edema by OCT compared to patients with episcleritis and normal eyes. OCT adds both qualitative and quantitative information to diagnosis and monitoring of patients with scleritis.