Scleromalacia Perforans is considered which type of anterior scleritis?

• A. Diffuse non-necrotizing
• B. Nodular non-necrotizing
• C. Necrotizing with inflammation
• D. Necrotizing without inflammation

Answer: (D)

The key idea is knowing how anterior scleritis is classified by both necrosis and inflammatory signs. Scleromalacia perforans is the form where the scleral tissue undergoes necrosis and thinning, but there are little to no inflammatory signs. That combination—necrosis with thinning yet minimal or no inflammation and often little pain—is what sets this condition apart. It frequently occurs in patients with rheumatoid arthritis and can be surprisingly painless, even though the sclera is thinning. On exam you’d see pale, thinned patches of sclera, sometimes with underlying choroidal visibility, and there’s a real risk of perforation if thinning progresses. Other forms involve active inflammation with pain and redness but without thinning, or involve both necrosis and inflammation, which would present with more conspicuous inflammatory signs and pain. So this description—necrotizing scleral thinning without inflammatory signs—best fits scleromalacia perforans.