Scleritis: Difference between revisions
(Text replacement - "==References== " to "==References== <references/> ") |
No edit summary |
||
| Line 4: | Line 4: | ||
**Reason why optic nerve edema and visual compromise are common complications | **Reason why optic nerve edema and visual compromise are common complications | ||
*50% of cases associated with an underlying disorder: | *50% of cases associated with an underlying disorder: | ||
**[[ | **[[Inflammatory bowel disease]] | ||
**Granulomatosis | **[[Rheumatoid arthritis]] | ||
**Granulomatosis with polyangiitis (Wegners) | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 16: | Line 16: | ||
*Globe tenderness to palpation | *Globe tenderness to palpation | ||
*Episcleral vessel dilation | *Episcleral vessel dilation | ||
===Posterior Scleritis=== | |||
*posterior to the insertion of the extraocular muscles | |||
*Physical exam often benign | |||
**Inflammation may sometimes be seen at the extremes of gaze | |||
*Patient complains of pain, pain upon EOM | |||
*Involvement of the optic nerve and retina is common | |||
**Retinal detachment, optic disc edema | |||
==DifferentialDiagnosis== | ==DifferentialDiagnosis== | ||
{{Unilateral red eye DDX}} | {{Unilateral red eye DDX}} | ||
| Line 25: | Line 32: | ||
**CBC | **CBC | ||
**Chemistry | **Chemistry | ||
**[[Urinalysis]] | **[[Urinalysis]] (evalute for glomerulonephritis) | ||
**ESR, CRP | **ESR, CRP | ||
===Imaging=== | ===Imaging=== | ||
| Line 48: | Line 47: | ||
==Complications== | ==Complications== | ||
*Cornea | *Cornea (peripheral ulcerative keratitis → irreversible loss of vision) | ||
*Uveal tract (anterior uveitis seen in 40% - spillover of inflammation from the sclera) | |||
*Uveal tract | *Posterior segment (retinal detachment, optic disc edema) | ||
*Posterior segment | |||
==See Also== | ==See Also== | ||
| Line 61: | Line 56: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
Revision as of 02:52, 9 June 2018
Background
- Potentially blinding disorder
- Sclera fuses with dura mater and arachnoid sheath of the opic nerve
- Reason why optic nerve edema and visual compromise are common complications
- 50% of cases associated with an underlying disorder:
- Inflammatory bowel disease
- Rheumatoid arthritis
- Granulomatosis with polyangiitis (Wegners)
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
Posterior Scleritis
- posterior to the insertion of the extraocular muscles
- Physical exam often benign
- Inflammation may sometimes be seen at the extremes of gaze
- Patient complains of pain, pain upon EOM
- Involvement of the optic nerve and retina is common
- Retinal detachment, optic disc edema
DifferentialDiagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Labs (to assess possible associated disease)
- CBC
- Chemistry
- Urinalysis (evalute for glomerulonephritis)
- ESR, CRP
Imaging
- Ultrasound and CT can show thickening of the sclera
Management
- 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)
- Posterior segment (retinal detachment, optic disc edema)