Relapsing polychondritis (RPC) is an immune-mediated systemic disease characterized by recurring inflammatory episodes in cartilage structures, mainly in the ears, nose, and respiratory tract. It is associated with various systemic and ocular manifestations, such as scleritis, the most common ocular feature of RPC. Scleromalacia perforans (SP) is a rare and severe form of anterior scleritis that appears as a dark bluish discoloration and bulging of a thinned-out sclera in the absence of pain or redness. This case report describes a 30-year-old Asian male who presented a seven-year history of blurred vision and recurrent eye redness. Visual acuity (VA) was 15/200 and 20/63+2 on OD and OS, respectively. An eye exam showed diffusely hazy cornea, thinned-out sclera, and elevated intraocular pressure (IOP) in both eyes. A systems review revealed bilateral auriculitis and mixed hearing loss. He was clinically diagnosed with RP and started on systemic corticosteroids at 1 mg/kg/day. On follow-up, the patient showed resolution of conjunctival hyperemia
however, IOP remains elevated despite maximal therapy. Ocular manifestations in RPC are protean and may be the presenting symptoms of RPC, resulting in the possibility of delayed or missed diagnosis in the absence of chondritis. SP, corneal scarring, and secondary glaucoma are late sequelae and vision-threatening conditions that may pose significant therapeutic challenges to ophthalmologists. Multispecialty collaboration is warranted in the management of systemic complications of RPC.