Scleritis

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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