Which type of scleritis is characterized by no ocular inflammation and a low risk for perforation?

Scleromalacia perforans is characterized by a degenerative process of the sclera that typically occurs without evident ocular inflammation. This condition is often seen in patients with long-standing rheumatoid arthritis or other autoimmune conditions. The inflammation is minimal, and the sclera may become thinned out, leading to tissue loss. However, because the inflammation is not acute and the underlying mechanism is more of a degenerative nature rather than an active inflammatory process, the risk of perforation is considered low.

In contrast, other forms of scleritis present with more significant inflammation and related complications. For example, nodular scleritis can present with localized areas of inflammation, and granulomatous necrotizing scleritis entails a more severe inflammatory response that heightens the risk for tissue damage and perforation. Anterior non-necrotizing diffuse scleritis also involves more extensive ocular inflammation, making it less characteristic of the low risk scenario seen in scleromalacia perforans. Thus, the absence of ocular inflammation and the associated low risk for perforation are defining features of scleromalacia perforans.