Unusual presentation of necrotic nodular scleritis.

Holthouse (I893) described painful ulceration in an apparent nodule of episcleritis, with resulting perforation of the globe (Duke-Elder, 1938). According to Francois (I95I), the case reported was not one of episcleritis but the represented first description of necrotic nodular scleritis. Watson (I966) states that the sclera is rarely involved in episcleritis. All forms of necrotizing scleritis are grouped under the term necrogranulomatous scleritis (Sevel, I965). Pain is an inconstant feature, being absent in scleromalacia perforans and present in rheumatic nodule (Ashton and Hobbs, I952) and necrotic nodular scleritis (Franceshcetti and Bischler, 1950). The following case report records painless scleral necrosis, initially presenting as a nodule of episcleritis, and its subsequent treatment by surgery.