4.3 Scleritis

4.3 Scleritis

Date of last review:

7/9/2026

Date of next review:

7/9/2028

Date of publication:

16/9/2026

Differential diagnosis (1)  

  • Episcleritis (typically less painful and self-limiting)

  • Other causes of acute painful red eye, including anterior uveitis

Possible management by optometrist 

Advice  

  • Advise sunglasses for relief of photophobia

Treatment 

Necrotising Anterior Scleritis / Posterior Scleritis is an ocular emergency and should be referred as an emergency to Ophthalmology (1)

Non-Necrotising Anterior Scleritis (mild–moderate)

  • Recommend over the counter oral NSAID’s (e.g. ibuprofen, naproxen) with advice from Pharmacist/GP on maximum safe dosage/duration (1,7)

  • Use NSAIDs with caution in (1):

    • Elderly patients

    • Those with systemic comorbidities

  • Paracetamol may be used where NSAIDs are contraindicated, with advice from pharmacist if needed (1,7)

Typical dosage/duration 

(Blue text = IP, black text = non-IP)

  • Not applicable for this condition (7)

Further management options (1)

Necrotising Anterior Scleritis / Posterior Scleritis

  • Ocular emergency

  • Management

    • Emergency referral to ophthalmology / A&E

    • Provide clear advice regarding urgency

    • Contact the receiving department to ensure the patient is expected and prioritised

    • No intervention in primary care other than analgesia

Non-Necrotising Anterior Scleritis

  • Initiate oral NSAID therapy (if appropriate)

  • Urgent referral to an ophthalmologist for further assessment and management

Possible management in secondary care or local/community pathways where available (1)

  • Investigation for underlying systemic disease (e.g. autoimmune conditions)

  • Imaging (e.g. B-scan ultrasonography) to investigate posterior segment involvement

  • Medical management may include:

    • Systemic NSAIDs

    • Topical and systemic corticosteroids

    • Systemic immunosuppressive therapy (including biologics)

  • Antimicrobial therapy in infective cases

  • Multidisciplinary management may be required (e.g. rheumatology input)

College of Optometrists Clinical Management Guideline (1)  

Scleritis - College of Optometrists *

* With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources 

  1. College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists

  2. Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists

  3. Advisory alignment with the BNF BNF (British National Formulary) | NICE

  4. Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)

  5. Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *

  6. Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above

  7. Advisory alignment with expert consensus (CEGG) 

  8. “Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page 

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot