Which type of anterior scleritis would present with the least pain?

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

Answer: (D)

Pain in anterior scleritis typically tracks the level of inflammation. Non-necrotizing forms (diffuse or nodular) involve active inflammation, so they usually present with noticeable pain. Necrotizing with inflammation carries even more pain due to ongoing necrosis and inflammatory damage. In contrast, necrotizing without inflammation often shows scleral thinning (scleromalacia perforans) with little or no inflammatory infiltrate, so the patient may report minimal or no pain despite significant structural changes. This painless necrosis is classically seen in long-standing autoimmune disease like rheumatoid arthritis, underscoring why it has the least pain among the options.