Scleritis Flashcards
What is episcleritis?
-Inflammation (acute onset) of the surface of the sclera (episclera)
-Usually self-limiting
What is scleritis?
Ocular emergency with a systemic cause in 50% of cases
=full-thickness inflammation
Anatomy of sclera
-Formed by coarsely-woven collagen bundles and so is white, opaque. It is consistent with the uveal tract (iris, ciliary body, choroid). It has 3 vascular layers
3 vascular layers of sclera
-Conjunctival vessels (tortuous)
-Superficial episcleral plexus (straight)
-Deep vascular plexus (purplish hue)
Cause of episcleritis
-Idiopathic
-IBD and RA
Causes of scleritis
-RA
-Granulomatosis with polyangiitis
-SLE
-Sarcoidosis
Symptoms and signs of episcleritis
-Redness (may be sectoral)
-Discomfort (mild-moderate), classically not too painful
-Grittiness ± mild photophobia
-Watering
-Often bilateral
-VA normal
-May be nodular
-Injected vessels are mobile when gentle pressure is applied to sclera
Symptoms and signs of scleritis
-Redness (diffuse, nodular, or necrotising)
-Deep severe boring ocular pain worse with eye movement radiating to temple or jaw ± ↓VA
-photophobia
-Gradual decrease in vision
-lacrimation
-Injected vessels do not move when gentle pressure is applied on the sclera
Investigations of scleritis
URGENT REFERRAL
-FBC, ESR, CRP, Rheumatology tests
-Phenylephrine drops= if redness improves episcleritis, if not scleritis as scleral vessels not blanched
Management of episcleritis
-TOP/ORAL NSAID± weak TOP steroid
-Artificial tears may sometimes be used
-May recur
Management of scleritis
-ORAL/IV steroids (pred)
-ORAL NSAIDs (ibuprofen) ± cytotoxic therapy (steroid sparing immunosuppressants like cyclophosphamide and azathioprine)
-Scleral graft
Complications of scleritis
-Keratitis (ulcerating, melting)
-Scleromalacia perforans (progressive scleral thinning)
-Posterior scleritis (choroidal folds)
