Search
scleritis
Inflammation of the sclera.
Etiology:
1) often associated with systemic disease
a) infection:
- syphilis
- post herpes zoster ophthalmicus
- tuberculosis
- Lyme disease
b) connective tissue disease (~ 50%)
- rheumatoid arthritis (~ 18%) (may be initial presentation) [3]
- systemic lupus erythematosus (SLE)
- vasculitis
- polyarteritis nodosa
- seronegative spondyloarthropathy
a] ankylosing spondylitis
b] psoriatic arthritis
c] reactive arthritis
d] enteropathic arthritis
- Wegener's granulomatosis (may be initial presentation) [3]
- relapsing polychondritis
- sarcoidosis (more likely to cause uveitis) [2]
- inflammatory bowel disease
- Sjogren syndrome
2) other
a) gout
b) foreign body
c) hypertension
3) idiopathic (50%)
Epidemiology:
1) uncommon
2) more common in women than men
Pathology:
- inflammatory disorder [2]
- pain due to traction of extraocular muscles on sclera
Clinical manifestations:
1) painful [2], often protracted course
- pain with gentle palation of eye globe
- pain may radiate to surrounding facial areas
- pain often worse at night & with eye movement [2]
2) focal conjunctival inflammation or inflammation may be more diffuse (red eye) sparing eyelids & iris
3) most commonly bilateral
4) photophobia, tearing
5) scleromalacia, violaceous hue of the eye globe
- results from vascular dilatation of the underlying vessels
5) visual impairment [2,3], or vision may be normal [2]
Laboratory:
1) depends on the clinical suspicion
2) complete blood count (CBC)
3) electrolytes
4) erythrocyte sedimentation rate (ESR)
5) serology for syphilis, RPR
6) serum uric acid
7) rheumatoid factor
8) antinuclear antibody (ANA)
Radiology:
1) B-scan ultrasonography may assist in detecting posterior scleritis
2) MRI or CT scans may play a role, but should be ordered in consultation with an ophthalmologist
3) Chest X-ray may be indicated to look for underlying pulmonary involvement arising from systemic disease
4) imaging of sacroiliac joints is prudent when ankylosing spondylitis is suspected
Differential diagnosis:
- episcleritis
- less commonly associated with eye pain & photophobia
- more commonly associated with red eye, eye irritation & tears [2]
Management:
- contact an ophthalmologist [2]
- subconjunctival glucocorticoid injections for non-necrotising scleritis [3]
- systemic anti-inflammatory or immunosuppressive therapy [3]
- biologic immunosuppressive agents may be of benefit in refractory cases [3]
Related
episcleritis
sclera
General
scleral disease
eye infection (ocular inflammation including eyelid inflammation)
References
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- Medical Knowledge Self Assessment Program (MKSAP) 11,16,17,18,19.
American College of Physicians, Philadelphia 1998,2012, 2015,2018, 2022
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Sims J
Scleritis: presentations, disease associations and management.
Postgrad Med J. 2012 Dec;88(1046):713-8.
PMID: 22977282