Necrogranulomatous scleritis (scleromalacia perforans) may be associated with rheumatoid arthritis (rheumatoid nodule of the sclera), with the necrotizing vasculitis group of diseases, or confined to the eye without overt evidence of associated systemic disease (Sevel, i965, i966, I967, i968a,b). The purpose of this paper is to review the clinical features of a further case of necrogranulomatous scleritis in the light of its present treatment. The value of a scleral onlay graft is described with special emphasis on its histology.
Case reportA white male retired book-keeper aged 71 years was first seen in the Eye Out-Patients Department of Groote Schuur Hospital on August I5, I967, when he complained of epiphora.
ExaminationThe visual acuity was 6/2 and 6/7 5 in the right and left eyes respectively. Both pupils were small and perilimbal injection was noted in association with circumferential corneal fluorescein staining. The intraocular tension was 30 mm. Hg in the right eye and 25 mm. Hg in the left. On this occasion both naso-lacrimal ducts were syringed and were found to be patent.
TreatmentChloramphenicol ointment was applied locally three times a day, and a week later the symptoms were less marked; there was no corneal staining but the eyes were still injected. Neosporin drops were prescribed three times a day. Course On October 3, I967, the eyes had become troublesome and much more injected and the patient complained of blurred vision, ocular itching, and epiphora. There were marginal subepithelial infiltrates with maximal conjunctival hyperaemia and oedema was evident over the upper halves of both eyes. As this area was tender a diagnosis of bilateral episcleritis was made and betamethasone drops three times a day were given in addition to the chloramphenicol ointment. Oxyphenbutasone tablets, one three times a day, were added to the regime but on November I4, 1967, patches of episcleritis were still evident near the superior limbus in both eyes. The visual acuity had improved to 6/5 in each eye, and with a near correction to N5.On January 9, I968, redness and oedema were noted in larger areas of the conjunctiva adjacent to the limbus. The patient now had a fluctuating course of improvement and exacerbation and on Receive(d for publication D)ecemober 21, 1971 Address for ieprioits: Prof. 1). Sevel, )epartment of Ophthalmology, tUiversity of Cape Tossn, Soutl Africa
