Pt of bl scleral thinning wd uveal ts prolapse no Ho ptergium excision or mmc use seeing d ot fr d last 10 yrs earlier it vs thinning only . Wts d treat modalies vn deterioring gn normal nothing abnormal otherwise

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Thank you Dr Gajjar! Your diagnosis is right.Necrotizing nodular scleritis eventually leads to scleromalacia perforans.This rare affection needs also to be differentiated from tuberculoma and spontaneous intercalary perforation.

Also thank u for other 2 d d .
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Perforation is beyond the limbus. So it is from scleral thinning most probably from autoimmune cause(collagen disease) . As the eye is white and quiet it looks like scleral melting. Also rule out wagners( unlikely in this case) .Agree with Dr Gajjar it being sleromalacia perforans. Full systemic investigation on line of collagen disease. Needs scleral graft on emergency basis

Appears like necrotizing scleritis leading to scleral perforation.

@Dr. E Ahmed Lack of inflammation seen in the picture is against necrotizing scleritis . It is most likely to be scleromalacia perforance where disease is chronic &, pain & inflammation r typically sbsent
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It looks like an OSSN.How do you suggest in a subject of 46 yrs having unilateral lesion to be a case of limbal type of VKC?Biopsy and its report will be needed to guide the management.

History of joint pain's?? Serological tests are mandatory to rule out autoimmune diseases,surgical treatment includes patch graft with amniotic membrane, and topical steroids, but before surgical intervention, please try IV cyclophosphamide once a month for 3 months and observe regression, monitor blood cells count regularly

Please , tell the diagnosis .
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Perhaps I am not right! Most probably Dr Gajjar's diagnosis is accurate-scleromalacia perforans0

Necrotizing scleritis

Though I have replied , lack of pain & inflammation & long duration of disease suggests against necrotizing scleritis It is most likely scleromalacia perforance .
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Scleromalacia perforance .

Sclera perforence autoimmunity

Most like Diag is scleromalcia perforance only . On next visit rpt investigations ll b done to rule out collagen disorders though an yr back all tests vr neg

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