Scleritis: Difference between revisions
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==Background== | ==Background== | ||
* Potentially blinding disorder | *Potentially blinding disorder | ||
*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 | ||
*50% of cases associated with an underlying disorder: | |||
**[[Inflammatory bowel disease]] | |||
**[[Rheumatoid arthritis]] | |||
**[[Granulomatosis with polyangiitis]] (Wegners) | |||
==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 [[eye pain|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 | ||
===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 | |||
===Complications=== | |||
*Cornea (peripheral ulcerative keratitis → irreversible [[vision loss|loss of vision]]) | |||
*Uveal tract (anterior [[uveitis]] seen in 40% - spillover of inflammation from the sclera) | |||
*Posterior segment ([[retinal detachment]], optic disc edema) | |||
==DifferentialDiagnosis== | ==DifferentialDiagnosis== | ||
{{Unilateral red eye DDX}} | {{Unilateral red eye DDX}} | ||
== | ==Evaluation== | ||
* Labs (to assess possible associated disease) | *Labs (to assess possible associated disease) | ||
** CBC | **CBC | ||
** Chemistry | **Chemistry | ||
** | **[[Urinalysis]] (evaluate for glomerulonephritis) | ||
**ESR, CRP | |||
** ESR, CRP | |||
===Imaging=== | ===Imaging=== | ||
*Ultrasound and CT can show thickening of the sclera | *[[ocular ultrasound|Ultrasound]] and CT can show thickening of the sclera | ||
==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 | ||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
Latest revision as of 21:54, 6 October 2019
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:
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
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)
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 (evaluate 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