Necrotizing Scleritis without Inflammation (Scleromalacia Perforans): A Case Report

Scleromalacia perforans SP is a rare ocular manifestation of rheumatoid arthritis which can potentially lead to blindness and is a late consequence in the course of the disease; in deed it is most common in elderly female with long-term rheumatoid arthritis, but it was also observed with other systemic diseases. It presents as a blackish blue hue visible through a thin sclera. scleral thinning is slow in onset and painless without inflammation. Progression can be prevented if treatment is instituted early. There is no specific and efficient treatment. As it develops on autoimmune abnormalities immunosuppressive therapy is proposed. To preserve globe integrity, scleral patch grafting with subsequent immunosuppression is performed.