101 - Scleritis

Abstract

Scleritis is usually a chronic, painful, progressive, potentially blinding condition involving both the episclera and the sclera. It may be associated with ocular complications (anterior uveitis, peripheral keratitis, and glaucoma), potentially causing decrease of vision. Scleritis may be idiopathic (50%) or associated with systemic connective tissue or vasculitic diseases (40%) or local or systemic infections (5%–10%). A comprehensive medical, ophthalmic history, and review of systems together with a complete ocular and physical exam are the cornerstones to the diagnosis of underlying systemic diseases, some of them potentially lethal. While in most cases the presence of a systemic disease is apparent prior to the diagnosis of scleral inflammation, scleritis may be the initial manifestation in about 15% of the cases, mainly granulomatosis with polyangiitis or relapsing polychondritis. The management of noninfectious scleritis requires nonsteroidal antiinflammatory drugs, corticosteroids, immunosuppressive agents, or biologic drugs, alone or in combination. Infectious scleritis may be caused by bacteria, viruses, fungi, and parasites. Subconjunctival nodules or abscesses with mucopurulent discharge may aid in the diagnosis, although sometimes the appearance may be identical to noninfectious scleritis. Patients with infectious scleritis should be treated with appropriate and specific antimicrobial therapy.