Self-inflicted anterior scleritis

Purpose: To describe and clinically characterize a syndrome of self-inflict ed scleritis, Study Design: Case reports and literature review. Methods: Two patients had persistent scleritis at presentation. Both did no t respond to prescribed therapy, including systemic corticosteroids and imm unosuppression, The first had unexplained, diffuse anterior scleritis and p ersistent linear keratoconjunctival abrasions after a work-related injury. Several objective indicators pointed to concealed noncompliance with medica tions. The second patient was a medical assistant with diffuse, unilateral anterior scleritis and unexplained visual loss. Systemic work-up was negati ve. She had pharmacologic mydriasis and keratoconjunctival abrasions at pre sentation. Results: Systemic therapy was stopped in both patients. The first patient, who was in the process of requesting permanent disability status, showed pe rsistent inflammation on each follow-up visit. The second patient improved with no further therapy after she was confronted with objective indicators of a self-inflicted condition. Conclusions: Although the presentation of self-inflicted scleritis can be s imilar to that of idiopathic or autoimmune anterior scleritis, the former m ay show additional findings of traumatic conjunctival and corneal abrasions . Indicators of self-inflicted etiology, of which malingering is one such e ntity, include evidence of concealed noncompliance with prescribed treatmen ts and lack of response to potent antiinflammatory and immunosuppressive ag ents. Correct diagnosis including early psychiatric evaluation in all such cases, may help prevent unnecessary treatment and unjustified work-related compensation. Ophthalmology 2001;108:192-195 (C) 2001 by the American Acade my of Ophthalmology.