Complications and Their Management

Abstract

Scleral inflammation may involve adjacent structures leading to keratitis, uveitis, glaucoma, cataract, and orbital inflammation. As a result of that, some patients may decrease their vision. Keratitis in scleritis involves the adjacent peripheral cornea and may be present in about 13% of patients. Peripheral keratitis in scleritis includes peripheral corneal thinning, stromal keratitis, and, the most severe form, peripheral ulcerative keratitis. Uveitis in scleritis is more frequently anterior, is mild to moderate in intensity, and appears during the late course of scleral inflammation; it may be present in about 26% of patients, mainly in those with necrotizing scleritis, peripheral ulcerative keratitis, and glaucoma indicating that extension of scleritis to the anterior uveal tract is a consequence of a more severe disease. The presence of scleritis-associated uveitis does not seem to correlate with the presence of any specific systemic disease. Increased intraocular pressure is most frequently caused by damage to the trabecular meshwork by anterior uveitis, overlying corneoscleral inflammation, and peripheral anterior synechiae; it may be present in 12–22% of patients, most often transiently during acute inflammatory episodes. Permanent visual field changes in these patients are less frequent. Posterior subcapsular cataract develops from intraocular inflammation or steroid treatment. Surgery should be attempted only in the absence of scleral inflammation and should be performed through clear corneal incision. The orbit and muscles around the globe frequently become involved in scleral inflammation and may be a significant factor in the pain felt by these patients.