Which type of anterior scleritis is associated with the highest risk of perforation?

Necrotizing anterior scleritis is associated with the highest risk of perforation due to the severe inflammatory process it involves. In this type, there is significant tissue destruction resulting from the inflammation, leading to the degradation of the scleral tissue. Unlike other forms of scleritis, necrotizing scleritis is characterized by a more aggressive course, often seen in patients with systemic diseases such as rheumatoid arthritis or other connective tissue disorders.

The destructive nature of necrotizing scleritis increases the vulnerability of the sclera, making it more prone to perforation—the complete inability to maintain the structural integrity of the eye. This condition may not only compromise the ocular surface but can also have serious implications for vision if not managed promptly and effectively. Regular monitoring and timely intervention are critical to managing the risk of perforation in patients with necrotizing scleritis.

On the other hand, the other forms of scleritis, such as nodular and diffuse scleritis, typically do not exhibit the same level of destructive inflammatory changes, and while they can certainly lead to complications, they generally carry a lower risk of perforation compared to necrotizing scleritis. Scleromalacia perforans, although also a severe condition, often