scleritis

DEFINITION of scleritis

Scleritis is a granulomatous or non-granulomatous inflammation involving the full thickness of the scleral tissue, which comprises the outer 5/6 of the fibrous tunic of the eye. Unlike the more superficial and benign episcleritis, scleritis involves the deep scleral vasculature and stroma, producing intense ocular pain that characteristically worsens with eye movement and may radiate to the periorbital region, temple, or jaw. The condition is characterized by deep, violaceous (bluish-red) injection of the scleral and episcleral vessels that does not blanch with topical phenylephrine — a key clinical distinguishing feature from episcleritis. Scleritis is classified anatomically as anterior (the most common, involving the anterior sclera) or posterior (involving the sclera behind the equator of the globe). Anterior scleritis is further subdivided into diffuse, nodular, necrotizing with inflammation, and necrotizing without inflammation (scleromalacia perforans). The necrotizing forms carry the most serious prognosis, with risk of globe perforation. Approximately 50% of cases are associated with a systemic condition, most commonly rheumatoid arthritis, granulomatosis with polyangiitis (formerly Wegener’s), systemic lupus erythematosus (SLE), relapsing polychondritis, inflammatory bowel disease, and reactive arthritis. Infectious etiologies (herpetic, tuberculous, syphilitic, fungal) must also be considered, particularly in cases refractory to standard therapy.

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ETYMOLOGY of scleritis

greek Sclero- Greek sklēros (σκληρός) Hard, firm -itis|Greek -itis Inflammation of

The sclera itself derives its name from its dense, tough collagen matrix. The suffix -itis denotes an inflammatory process, making scleritis literally “inflammation of the hard [coat]” — a reference to the fibrous, unyielding nature of the scleral tissue.

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RELATED TERMS

• episcleritis — Superficial inflammation of the episcleral tissue; milder, self-limiting, not typically associated with systemic disease; does NOT involve full scleral thickness
• Uveitis — Inflammation of the uveal tract; may occur concurrently with or secondary to scleritis
• Keratoscleritis — Scleritis with concomitant corneal involvement (peripheral ulcerative keratitis, PUK)
• Sclerocornea — Congenital opacification of the cornea, distinct from scleritis
• Scleral thinning / ectasia — Sequela of necrotizing scleritis
• granulomatosis with polyangiitis (GPA) — One of the most common systemic associations
• Rheumatoid arthritis (RA) — Most common systemic disease linked to scleritis overall
• Tenon’s capsule — Fibrous envelope surrounding the globe, often involved in posterior scleritis
• Phenylephrine blanching test — Negative in scleritis (vessels don’t blanch); positive in episcleritis

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CODING AND NUANCES

ICD-10-CM CODES

🔷 Scleritis — Core Codes (Category H15.0)

Code	Description
H15.001	Unspecified scleritis, right eye
H15.002	Unspecified scleritis, left eye
H15.003	Unspecified scleritis, bilateral
H15.009	Unspecified scleritis, unspecified eye
H15.011	Anterior scleritis, right eye
H15.012	Anterior scleritis, left eye
H15.013	Anterior scleritis, bilateral
H15.019	Anterior scleritis, unspecified eye
H15.021	Brawny scleritis, right eye
H15.022	Brawny scleritis, left eye
H15.023	Brawny scleritis, bilateral
H15.029	Brawny scleritis, unspecified eye
H15.031	Posterior scleritis, right eye
H15.032	Posterior scleritis, left eye
H15.033	Posterior scleritis, bilateral
H15.039	Posterior scleritis, unspecified eye
H15.041	Scleritis with corneal involvement, right eye
H15.042	Scleritis with corneal involvement, left eye
H15.043	Scleritis with corneal involvement, bilateral
H15.049	Scleritis with corneal involvement, unspecified eye
H15.091	Other scleritis, right eye
H15.092	Other scleritis, left eye
H15.093	Other scleritis, bilateral
H15.099	Other scleritis, unspecified eye

🔷 Infectious / Systemic Etiology Scleritis Codes

Code	Description
B02.34	Zoster scleritis
A18.51	Tuberculous episcleritis (note: no separate TB scleritis code; code also A18.51 + H15.0x for TB scleritis)

🔷 Related / Commonly Coded Together

Code	Description
H15.101	Unspecified episcleritis, right eye
H15.102	Unspecified episcleritis, left eye
H15.103	Unspecified episcleritis, bilateral
H15.109	Unspecified episcleritis, unspecified eye
H15.111	Episcleritis periodica fugax, right eye
H15.113	Episcleritis periodica fugax, bilateral
H15.121	Nodular episcleritis, right eye
H15.122	Nodular episcleritis, left eye
H15.123	Nodular episcleritis, bilateral

⚠️ Coder’s Note: ICD-10-CM codes in category H15 are 7 characters for most laterality-specific codes. Always assign the most specific code available. When scleritis is secondary to a systemic condition (RA, GPA, SLE, etc.), code the underlying disease first per etiology/manifestation sequencing rules if applicable. For zoster scleritis, B02.34 is a combination code and does not require an additional H15 code.

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CPT CODES (Relevant to Scleritis Workup & Management)

CPT Code	Description
92002	Ophthalmological services, new patient — intermediate examination
92004	Ophthalmological services, new patient — comprehensive examination
92012	Ophthalmological services, established patient — intermediate examination
92014	Ophthalmological services, established patient — comprehensive examination
92250	Fundus photography with interpretation and report (useful in posterior scleritis)
92132	Scanning computerized ophthalmic diagnostic imaging, anterior segment, unilateral
92133	OCT, optic nerve — used to r/o posterior segment involvement
92134	OCT, retina — posterior scleritis evaluation
76510	Ophthalmic ultrasound, B-scan (critical for diagnosing posterior scleritis — the “T-sign”)
68100	Biopsy of conjunctiva (occasionally used to r/o infectious or neoplastic etiology)
65125	Modification of ocular implant (rarely applicable, but used in surgical scleral repair cases)
99213-99215	E&M office visit codes (used when billing under medical, not ophthalmological, services)

💡 Coder’s Tip: B-scan ultrasonography (76510) is the gold standard for diagnosing posterior scleritis — the hallmark “T-sign” (fluid in Tenon’s space) is pathognomonic. Make sure documentation supports medical necessity when coding this. Also note that 92132-92134 (OCT series) are laterality-specific and should reflect documentation of which eye(s) were imaged.

All ICD-10-CM codes verified as valid for HIPAA transactions.

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DERIVATIONS of scleritis

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Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms