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What is it?
Scleritis is a focal or diffuse inflammation of the sclera. It is often associated with a necrotizing systemic vasculitis, such as rheumatoid arthritis or Wegener's granulomatosis.

How does it present?
With severe ocular pain and a red eye. The conjunctival vessels are often especially dilated at a spot remote from the cornea. The underlying sclera may be thinned enough that the dark purple color of the underlying uvea shows through. Continued inflammation may lead to extreme thinning ("melting") of the cornea or sclera and even perforation of the globe.

What to do?
Refer urgently to an ophthalmologist. The diagnosis is difficult and treatment may present problems. Scleritis requires systemic corticosteroids or other immune-modulating agents. Threatened ocular perforation in scleritis may require surgical patch grafts. An evaluation for a systemic autoimmune disease is appropriate if no such diagnosis already exists.

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