Scleritis: Difference between revisions
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==Background== | |||
* Potentially blinding disorder | * Potentially blinding disorder | ||
* 50% of cases associated with an underlying disorder | * 50% of cases associated with an underlying disorder | ||
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** Explains why optic nerve edema and visual compromise are common complications | ** Explains why optic nerve edema and visual compromise are common complications | ||
==Diagnosis== | |||
* History | * History | ||
** Intense ocular pain that radiates to the face | ** Intense ocular pain that radiates to the face | ||
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*** Retinal detachment, optic disc edema | *** Retinal detachment, optic disc edema | ||
==Imaging== | |||
Ultrasound and CT can show thickening of the sclera | Ultrasound and CT can show thickening of the sclera | ||
==Treatment== | |||
* Systemic therapy with NSAIDs, glucocorticoids, or other immunosuppressive drugs | * Systemic therapy with NSAIDs, glucocorticoids, or other immunosuppressive drugs | ||
* NSAIDs | * NSAIDs | ||
** Indomethacin 25-75mg PO TID | ** Indomethacin 25-75mg PO TID | ||
==Dispo== | |||
* Urgent ophto consult | * Urgent ophto consult | ||
==Complications== | |||
* Cornea | * Cornea | ||
** Peripheral ulcerative keratitis > irreversible loss of vision | ** Peripheral ulcerative keratitis > irreversible loss of vision | ||
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** Retinal detachment, optic disc edema | ** Retinal detachment, optic disc edema | ||
== | ==See Also== | ||
[[Episcleritis]] | |||
==Source== | ==Source== | ||
Revision as of 20:39, 14 July 2011
Background
- Potentially blinding disorder
- 50% of cases associated with an underlying disorder
- RA
- Wgener's
- IBD
- Sclera fuses with the dura mater and arachnoid sheath of the opic nerve
- Explains why optic nerve edema and visual compromise are common complications
Diagnosis
- History
- Intense ocular pain that radiates to the face
- Pain with EOM (the extraocular muscles insert into the sclera)
- Photophobia
- Deep-red or purplish scleral hue
- Physical
- Essential sign is scleral edema, usually accompanied by violaceous discoloration of the globe
- The globe is tender to palpation
- Episcleral vessel dilation
- 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
Treatment
- Systemic therapy with NSAIDs, glucocorticoids, or other immunosuppressive drugs
- NSAIDs
- Indomethacin 25-75mg PO TID
Dispo
- Urgent ophto 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