Difference between revisions of "Scleritis"

(Text replacement - "==References== " to "==References== <references/> ")
 
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**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:
 
*50% of cases associated with an underlying disorder:
**[[RA]]
+
**[[Inflammatory bowel disease]]
**Granulomatosis w/polyangiitis (Wegners)
+
**[[Rheumatoid arthritis]]
**[[IBD]]
+
**Granulomatosis with polyangiitis (Wegners)
  
 
==Clinical Features==
 
==Clinical Features==
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*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
  
 
==DifferentialDiagnosis==
 
==DifferentialDiagnosis==
 
 
{{Unilateral red eye DDX}}
 
{{Unilateral red eye DDX}}
  
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**CBC
 
**CBC
 
**Chemistry
 
**Chemistry
**[[Urinalysis]]
+
**[[Urinalysis]] (evalute for glomerulonephritis)
***Rule-out glomerulonephritis
 
 
**ESR, CRP
 
**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 complains of pain, pain upon EOM
 
**Involvement of the optic nerve and retina is common
 
***Retinal detachment, optic disc edema
 
  
 
===Imaging===
 
===Imaging===
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==Complications==
 
==Complications==
*Cornea
+
*Cornea (peripheral ulcerative keratitis irreversible loss of vision)
**Peripheral ulcerative keratitis > irreversible loss of vision
+
*Uveal tract (anterior uveitis seen in 40% - spillover of inflammation from the sclera)
*Uveal tract
+
*Posterior segment (retinal detachment, optic disc edema)
**Anterior uveitis seen in 40%
 
***Spillover of inflammation from the sclera
 
*Posterior segment
 
**Retinal detachment, optic disc edema
 
  
 
==See Also==
 
==See Also==
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==References==
 
==References==
 
<references/>
 
<references/>
 +
 
[[Category:Ophthalmology]]
 
[[Category:Ophthalmology]]

Latest revision as of 02:52, 9 June 2018

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

Non-mobile inflammation of entire scleral thickness
  • 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

DifferentialDiagnosis

Unilateral red eye

^Emergent diagnoses

^^Critical diagnoses

Evaluation

  • Labs (to assess possible associated disease)
    • CBC
    • Chemistry
    • Urinalysis (evalute 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

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

References