What is your approach to evaluation of underlying autoimmune disease in patients with bilateral scleromalacia?

Scleromalacia perforans is an uncommon form of scleritis wherein there is scleral melt in an otherwise white/quiet appearing eye. The most common systemic association for scleromalacia perforans is with long standing rheumatoid arthritis. Other etiologies of scleritis should also be considered: systemic vasculitides, lupus, inflammatory bowel disease, spondyloarthropathy, relapsing polychondritis, sarcoidosis, cryoglobulinemia. Infectious associations for scleritis (although I don't usually think of these presenting as the scleromalacia perforans form of scleritis) include herpes simplex, herpes zoster, tuberculosis, syphilis, hepatitis C. Scleral thinning can also be a feature of surgically induced necrosis or following trauma although, I ...