Scleritis: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Treatment==" to "==Management==") |
Neil.m.young (talk | contribs) (Text replacement - "* " to "*") |
||
| Line 1: | Line 1: | ||
==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 dura mater and arachnoid sheath of the opic nerve | *Sclera fuses with dura mater and arachnoid sheath of the opic nerve | ||
**Reason why optic nerve edema and visual compromise are common complications | **Reason why optic nerve edema and visual compromise are common complications | ||
| Line 10: | Line 10: | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Scleritis.png|thumb|Non-mobile inflammation of entire scleral thickness]] | [[File:Scleritis.png|thumb|Non-mobile inflammation of entire scleral thickness]] | ||
* Essential sign is scleral edema, usually accompanied by violaceous discoloration of the globe | *Essential sign is scleral edema, usually accompanied by violaceous discoloration of the globe | ||
* Intense ocular pain that radiates to the face | *Intense ocular pain that radiates to the face | ||
* Pain with EOM (extraocular muscles insert into the sclera) | *Pain with EOM (extraocular muscles insert into the sclera) | ||
* Photophobia | *Photophobia | ||
* Globe tenderness to palpation | *Globe tenderness to palpation | ||
* Episcleral vessel dilation | *Episcleral vessel dilation | ||
==DifferentialDiagnosis== | ==DifferentialDiagnosis== | ||
| Line 22: | Line 22: | ||
==Diagnosis== | ==Diagnosis== | ||
* Labs (to assess possible associated disease) | *Labs (to assess possible associated disease) | ||
** CBC | **CBC | ||
** Chemistry | **Chemistry | ||
** UA | **UA | ||
*** Rule-out glomerulonephritis | ***Rule-out glomerulonephritis | ||
** ESR, CRP | **ESR, CRP | ||
* Posterior Scleritis (posterior to the insertion of the extraocular muscles) | *Posterior Scleritis (posterior to the insertion of the extraocular muscles) | ||
** Physical exam often benign | **Physical exam often benign | ||
*** Inflammation may sometimes be seen at the extremes of gaze | ***Inflammation may sometimes be seen at the extremes of gaze | ||
** Patient c/o pain, pain upon EOM | **Patient c/o pain, pain upon EOM | ||
** Involvement of the optic nerve and retina is common | **Involvement of the optic nerve and retina is common | ||
*** Retinal detachment, optic disc edema | ***Retinal detachment, optic disc edema | ||
===Imaging=== | ===Imaging=== | ||
| Line 40: | Line 40: | ||
==Management== | ==Management== | ||
* 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 | ||
==Disposition== | ==Disposition== | ||
* Urgent ophtho consult | *Urgent ophtho consult | ||
==Complications== | ==Complications== | ||
* Cornea | *Cornea | ||
** Peripheral ulcerative keratitis > irreversible loss of vision | **Peripheral ulcerative keratitis > irreversible loss of vision | ||
* Uveal tract | *Uveal tract | ||
** Anterior uveitis seen in 40% | **Anterior uveitis seen in 40% | ||
*** Spillover of inflammation from the sclera | ***Spillover of inflammation from the sclera | ||
* Posterior segment | *Posterior segment | ||
** Retinal detachment, optic disc edema | **Retinal detachment, optic disc edema | ||
==See Also== | ==See Also== | ||
Revision as of 01:34, 9 July 2016
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
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
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
- Patient 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
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
- Anterior uveitis seen in 40%
- Posterior segment
- Retinal detachment, optic disc edema