Scleritis testing includes which of the following?

• A. Phenyl 2.5% (no blanching), NaFl, DFE, Bloodwork (HLAB27, ANA, RF, ESR, CRP, CBC with diff, uric acid)
• B. Visual acuity testing and intraocular pressure measurement only
• C. Blood pressure measurement only
• D. No testing is required

Answer: (A)

Scleritis assessment combines targeted ocular testing with systemic evaluation because true scleral inflammation often accompanies systemic autoimmune or inflammatory conditions, and distinguishing it from similar anterior segment diseases guides management.

The phenylephrine test helps separate episcleritis from scleritis: after applying 2.5% phenylephrine, episcleritis vessels blanch due to superficial involvement, whereas scleral vessels in scleritis do not blanch because deeper scleral inflammation is present. “No blanching” supports scleral involvement.

Fluorescein staining is used to assess the ocular surface and cornea for any secondary involvement, while a dilated fundus exam checks for posterior segment disease that can accompany scleral inflammation.

Bloodwork including HLA-B27, ANA, RF, ESR, CRP, CBC with differential, and uric acid screens for systemic autoimmune or inflammatory conditions that may underlie the scleritis and influence therapy decisions.

So this combined approach—phenylephrine testing, fluorescein evaluation, dilated fundus exam, and relevant bloodwork—best covers both the local and systemic aspects of scleritis.