Article Text

Download PDFPDF
Histopathological evaluation of scleritis
  1. Mark Hankins1,
  2. Curtis Edward Margo1,2
  1. 1 Department of Ophthalmology, USF Health Morsani College of Medicine, Tampa, Florida, USA
  2. 2 Department of Dermatopathology, USF Health Morsani College of Medicine, Tampa, Florida, USA
  1. Correspondence to Dr Curtis Edward Margo, Dermatopathology, USF Health Morsani College of Medicine, Tampa 33612, Florida, USA ; cmargo{at}


The sclera is an uncommon site of primary inflammation. Biopsy is infrequently employed in the evaluation of scleritis, but familiarity with its differential diagnosis is instrumental in ensuring efficient histological evaluation. This review provides a clinical overview of scleritis and describes the context in which scleral biopsy might arise. Most cases are associated with systemic autoimmune disease, but a sizeable proportion occur as an isolated disorder. Conditions mimicking autoimmune scleritis include infection and neoplasm. Histological patterns of inflammation in eyes removed surgically or at autopsy have been placed into three groups: (1) autoimmune scleritis characterised by varying mixtures of palisading granulomas, necrosis and vasculitis; (2) infectious scleritis, characterised by acute inflammation and necrosis; and (3) idiopathic scleritis, characterised by chronic non-specific inflammation with follicles and varying amounts of fibrosis. This traditional system of classification may be oversimplified. Aetiological or categorical classification is not always possible on small biopsies given the histopathological overlap of infectious and non-infectious scleritis.

  • ocular pathology
  • histopathology
  • ophthalmology
  • inflammation
  • autoimmunity
  • Scleritis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Tahir S Pillay.

  • Contributors Both authors have contributed to the literature review and writing of this paper. Both have read the final draft and approved its submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.