Scleritis Flashcards
Describe scleritis (what it is, the difference between anterior and posterior segments, can it lead to vision loss, age onset)
- Note: sclera is avascular, and has rich nerve supply
- chronic granulomatous inflammation
- Anterior Scleritis: patient presents with eye redness and SEVERE eye pain
- Posterior Scleritis: no redness and may not have eye pain
- may lead to blindness and eye loss
- 50% may have underlying disease (CT disease: i.e. rheumatoid arthiritis)
- onset 40-60 years old
- may lead to tissue destruction and perforation
What are some signs of scleritis?
- inflammation of scleral, episcleral & conjunctival vessels
- injection of sclera and conjunctiva
- bluish tint
- choroidal vasculatures - intraocular complications (i.e. uveitis, retinal detachment, glaucoma, cataracts, corneal keratitis)
What are some symptoms of scleritis?
- Severe deep boring pain
- gradual onset with red eye, decreased VA
- recurrent
What is the differential diagnosis between scleritis and episcleritis?
- Episcleritis:
- blood vessels blanch with phenylephrine
- more acute onset
- patients tend to be younger and have mild symptoms
What is the most common systemic causes of scleritis related to connective tissue disease?
- 50% associated with systemic disease
- Rheumatoid arthritis
Explain the difference between diffuse and nodular anterior scleritis (necrotizing? does it affect vision, which is most common?)
- Non-necrotizing, vision maintained unless uveitis occurs
- Diffuse: widespread inflammation (most common and benign)
- Nodular: erythromatous, immovable, tender inflammed nodules (20% profress to necrotizing scleritis)
What is the treatment for diffuse and nodular anterior scleritis?
- Oral NSAID: ibuprofen 400-600 mg QID or naproxen 250-500 mg BID
- Oral prednisone 60-100 mg, QD x 1, may taper
- immunosuppressive therapy: systemic steroids
Describe necrotizing anterior scleritis?
severity, affects vision, systemic associations?
- Necrotizing is most severe form
- vision threatening
- inflammation: frequently accompanies collagen disorder (rhematoid arthritis)
- necrosis/avascular patch (cell death)
What are the signs of Anterior necrotizing scleritis with inflammation?
- scleral thinning, blue tinge
- Gradual, extremely painful
- if associated with corneal inflammation - sclerokeratitis
- conjunctiva may perforate
- Opthalmic emergency
What are secondary ocular complications with Anterior necrotizing scleritis with inflammation?
- Sclerosing keratitis
- cataracts
- hyphema
- staphyloma
- secondary glaucoma
What is Staphyloma?
- localized thinning of sclera
- bulging of uvea
- scleritis, myopia, RD, CT disease
- BIO exams, A & B scans
Describe Anterior necrotizing scleritis without inflammation (Scleromalacia perforans)
- frequently occurs with patients with rheumatoid arthritis
- NO PAIN
- visible avascular patch
- tissue thins, necrotizes and slough
- steady progressions
What is the treatment for necrotizing scleritis?
A. oral predisone B. immunosuppressive agents C. lubricating agents D. Scleral patch grafting if severe E. All of the above
E. All of the above
- oral prednisone
- immunosuppressive agents (cyclosporin)
- lubrication
Severe cases: scleral patch grafting
Describe general signs of posterior scleritis (2%) (EOM’s, vision, related to systemic?)
- non-pigmented choroidal mass
- restricted EOM’s
- proptosis, pain, tenderness
- permenant decreased vision
- usually unrelated to systemic diseases
Differential: retrobulbar optic neuritis, retinal detachment, tumor, orbital disease
Describe ocular signs of posterior scleritis
- disc swelling
- macular edema
- retinal hemorrhage and detachment
- intraretinal white spots from inflammation
- vitritis
- choroidal folds
