scleritis
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Introduction
Inflammation of the sclera.
Etiology
- often associated with systemic disease
- infection:
- connective tissue disease (~ 50%)
- rheumatoid arthritis (~ 18%) (may be initial presentation)[3]
- systemic lupus erythematosus (SLE)
- vasculitis
- seronegative spondyloarthropathy
- Wegener's granulomatosis (may be initial presentation)[3]
- relapsing polychondritis
- sarcoidosis (more likely to cause uveitis)[2]
- inflammatory bowel disease
- Sjogren syndrome
- other
- idiopathic (50%)
Epidemiology
- uncommon
- more common in women than men
Pathology
- inflammatory disorder[2]
- pain due to traction of extraocular muscles on sclera
Clinical manifestations
- painful[2], often protracted course
- pain with gentle palation of eye globe
- pain may radiate to surrounding facial areas
- pain often worse at night & with eye movement[2]
- focal conjunctival inflammation or inflammation may be more diffuse (red eye) sparing eyelids & iris
- most commonly bilateral
- photophobia, tearing
- scleromalacia, violaceous hue of the eye globe
- results from vascular dilatation of the underlying vessels
- visual impairment[2][3], or vision may be normal[2]
Laboratory
- depends on the clinical suspicion
- complete blood count (CBC)
- electrolytes
- erythrocyte sedimentation rate (ESR)
- serology for syphilis, RPR
- serum uric acid
- rheumatoid factor
- antinuclear antibody (ANA)
Radiology
- B-scan ultrasonography may assist in detecting posterior scleritis
- MRI or CT scans may play a role, but should be ordered in consultation with an ophthalmologist
- Chest X-ray may be indicated to look for underlying pulmonary involvement arising from systemic disease
- imaging of sacroiliac joints is prudent when ankylosing spondylitis is suspected
Differential diagnosis
- episcleritis
- less commonly associated with eye pain & photophobia
- more commonly associated with red eye, eye irritation & tears[2]
Management
- contact an ophthalmologist[2]
- subconjunctival glucocorticoid injections for non-necrotising scleritis[3]
- systemic anti-inflammatory or immunosuppressive therapy[3]
- biologic immunosuppressive agents may be of benefit in refractory cases[3]
More general terms
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Jump up to: 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Medical Knowledge Self Assessment Program (MKSAP) 11,16,17,18,19. American College of Physicians, Philadelphia 1998,2012, 2015,2018, 2022
- ↑ Jump up to: 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ Sims J Scleritis: presentations, disease associations and management. Postgrad Med J. 2012 Dec;88(1046):713-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22977282