Which type of anterior scleritis would most likely present with a blue sclera?

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

Answer: (B)

Blue sclera appears when the sclera becomes thin enough for underlying uveal tissue to show through the normally opaque white. In anterior scleritis, thinning and necrosis are most pronounced in necrotizing forms. When necrotizing scleritis occurs without active inflammation, there is significant scleral thinning without the overpowering redness or pain of inflammation, so the blue hue from the underlying vessels is more likely to be visible. In contrast, non-necrotizing forms and necrotizing forms with inflammation tend to present with marked redness and opaque, inflamed sclera, which masks any blue coloration. So the presentation most likely to show a blue sclera is thinning from necrotizing scleritis without inflammation.