Jornal de Oftalmologia Clínica e Experimental
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Scleromalacia Perforans–What We Know and What We Can Do

Dorot Kopacz, Piotr Maciejewicz and Mieczysław Kopacz

Anterior necrotizing scleritis without inflammation, so called scleromalacia perforans, is a rare, severe eye disorder developing on autoimmune damage of episcleral and scleral performing vessels (hypersensitivity type III). The onset of the disease is insidious, progression is slow and no specific symptoms are observed until discoloration of the sclera (necrotic slough, bare choroid) is detected. Scleromalacia perforans is most common in women with long-term rheumatoid arthritis, but it was also observed with other systemic diseases. There is no specific and efficient treatment. As it develops on autoimmune abnormalities immunosuppressive therapy is proposed. To preserve globe integrity, scleral patch grafting (both tissues and synthetic materials) with subsequent immunosuppression is performed.