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PURPOSE The goal of this work was to analyze optical coherence tomography (OCT) findings compared to ophthalmic examination results in the management of anterior scleritis. METHODS We carried out a prospective study including patients presenting with anterior scleritis who underwent complete clinical examinations and OCT at baseline and at the final follow-up visit. RESULTS The mean age was 46years. The superior and temporal quadrants were clinically the most involved regions and showed the greatest thickness on the OCT images. Nodules were observed clinically in 6 patients, while OCT revealed them in 9 cases. OCT revealed 3 cases of sub-clinical necrosis. Separation of fibers, scleral edema, dilated vessels, fluid pockets and increased scleral thickness were the most common signs of the disease. Mean total scleral thickness and mean scleral-episcleral complex thickness were significantly improved after treatment (P=0.001 and P=0.00; respectively). Post-streptococcal syndrome (PSS) was diagnosed in 3 cases of non-necrotizing anterior scleritis. Necrotizing forms were low-grade and were associated with systemic diseases in 2 out of 3 patients. OCT signs persisted for a substantial time after resolution of clinical signs. CONCLUSION OCT helped to distinguish necrosis and scleral nodules in subclinical cases. Non-necrotizing forms of scleritis supported the diagnosis of PSS, while necrotizing forms suggested systemic diseases. Complete resolution of a scleral inflammation could be followed more objectively with OCT than by clinical examination.