Scleritis

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

Imaging

• Ultrasound and CT can show thickening of the sclera

DDx

1. Episcleritis
2. Conjunctivitis
3. 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
• Posterior segment
  • Retinal detachment, optic disc edema

See Also

Episcleritis

Source

UpToDate