Scleritis: Difference between revisions
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==Background== | ==Background== | ||
* Potentially blinding disorder | * Potentially blinding disorder | ||
* 50% of cases associated with an underlying disorder | * 50% of cases associated with an underlying disorder: | ||
** RA | ** RA | ||
** Wgener's | ** Wgener's | ||
** IBD | ** IBD | ||
* Sclera fuses with | *Sclera fuses with dura mater and arachnoid sheath of the opic nerve | ||
** | **Reason why optic nerve edema and visual compromise are common complications | ||
==Clinical Features== | |||
* Essential sign is scleral edema, usually accompanied by violaceous discoloration of the globe | |||
* Intense ocular pain that radiates to the face | |||
* Pain with EOM (extraocular muscles insert into the sclera) | |||
* Photophobia | |||
* Globe tenderness to palpation | |||
* Episcleral vessel dilation | |||
==Diagnosis== | ==Diagnosis== | ||
* Labs (to assess possible associated disease) | * Labs (to assess possible associated disease) | ||
** CBC | ** CBC | ||
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===Imaging=== | ===Imaging=== | ||
Ultrasound and CT can show thickening of the sclera | *Ultrasound and CT can show thickening of the sclera | ||
==DDx== | ==DDx== | ||
| Line 46: | Line 45: | ||
==Disposition== | ==Disposition== | ||
* Urgent | * Urgent ophtho consult | ||
==Complications== | ==Complications== | ||
Revision as of 05:13, 20 March 2012
Background
- Potentially blinding disorder
- 50% of cases associated with an underlying disorder:
- RA
- Wgener's
- IBD
- Sclera fuses with dura mater and arachnoid sheath of the opic nerve
- Reason why optic nerve edema and visual compromise are common complications
Clinical Features
- Essential sign is scleral edema, usually accompanied by violaceous discoloration of the globe
- Intense ocular pain that radiates to the face
- Pain with EOM (extraocular muscles insert into the sclera)
- Photophobia
- Globe tenderness to palpation
- Episcleral vessel dilation
Diagnosis
- Labs (to assess possible associated disease)
- CBC
- Chemistry
- UA
- Rule-out glomerulonephritis
- ESR, CRP
- Posterior Scleritis (posterior to the insertion of the extraocular muscles)
- Physical exam often benign
- Inflammation may sometimes be seen at the extremes of gaze
- Pt c/o pain, pain upon EOM
- Involvement of the optic nerve and retina is common
- Retinal detachment, optic disc edema
- Physical exam often benign
Imaging
- Ultrasound and CT can show thickening of the sclera
DDx
- Episcleritis
- Conjunctivitis
- Herpes Keratitis
Treatment
- Systemic therapy with NSAIDs, glucocorticoids, or other immunosuppressive drugs
- NSAIDs
- Indomethacin 25-75mg PO TID
Disposition
- Urgent ophtho consult
Complications
- Cornea
- Peripheral ulcerative keratitis > irreversible loss of vision
- Uveal tract
- Anterior uveitis seen in 40%
- Spillover of inflammation from the sclera
- Anterior uveitis seen in 40%
- Posterior segment
- Retinal detachment, optic disc edema
See Also
Source
UpToDate