Scleritis: Difference between revisions

No edit summary
(No difference)

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

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
  • Posterior segment
    • Retinal detachment, optic disc edema

See Also

Episcleritis

Source

UpToDate