Scleritis - Causes of Arthritis and Scleritis

Scleritis

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See Also
Sclera
Episcleritis
Epidemiology
Rare
Pathophysiology
Severe Scleral inflammation
Variations
Nodular Scleritis
Necrotizing Scleritis (most destructive)
Anterior Scleritis (deep to Conjunctiva)
Posterior Scleritis (overlying retina)
Causes
Idiopathic in 50% of cases
Connective tissue disease
Rheumatoid Arthritis (most common cause)
Accounts for up to one third of scleritis cases
Scleritis occurs in 4-10% of RA cases
Wegener's Granulomatosis
Polyarteritis Nodosa
Systemic Lupus Erythematosus
Relapsing Polychondritis
Reiter's Syndrome
Psoriatic Arthritis
Ankylosing Spondylitis
Inflammatory Bowel Disease
Crohn's Disease
Ulcerative Colitis
Infectious (uncommon)
Herpes Zoster
Herpes Simplex Virus
Pseudomonas
Aspergillus
Tuberculosis
Symptoms
Red eye involving one or both eyes
Blurred vision
Photophobia
Significant Eye Pain (especially necrotizing scleritis)
Deep boring toothace-type Eye Pain
Pain radiates to eyebrows, cheeks and temples
Signs
Decreased Visual Acuity
Pain on palpation
Signs: Slit Lamp Exam
Localized, raised hyperemia of Sclera
Elevated Scleral vessels
Scleritis does not blanch with topical Phenylephrine
Phenylephrine blurs vision for 3 hours
Phenylephrine contraindicated in Glaucoma
Avascular areas over Sclera
Associated eye conditions
Anterior Scleritis
Iritis
Glaucoma
Posterior Scleritis
Retinal Detachment
Proptosis
Differential Diagnosis
See Red Eye
Episcleritis
Conjunctivitis
Management
Indomethacin or other NSAIDs
Ophthalmology referral
Advanced cases may require immunosuppressants
Course
Duration of months to years
Complications
Scleral thinning or perforation
Staphyloma
Scleromalacia perforans (in Rheumatoid Arthritis)
References
Goldstein in Yanoff (1999) Ophthalmology, p. 13.1
Ruddy (2001) Kelley's Rheumatology, Saunders, p. 396
Nakla (1998) Gastroenterol Clin North Am 27:697

Refers to any inflammation of the sclera including episcleritis, a benign condition affecting only the episclera, which is generally short-lived and easily treated. Classic scleritis, on the other hand, affects deeper tissue and is characterized by higher rates of visual acuity loss and even mortality, particularly in necrotizing form. Its characteristic symptom is severe and general head pain. Scleritis has also been associated with systemic collagen disease. Etiology is unknown but is thought to involve a local immune response. Treatment is difficult and includes administration of anti-inflammatory and immunosuppressive agents such as corticosteroids. Inflammation of the sclera may also be secondary to inflammation of adjacent tissues, such as the conjunctiva.
Concepts Disease or Syndrome (T047)
ICD9 379.00
MSH D015423
English Scleritides, Scleritis, Unspecified scleritis
Spanish escleritis, escleritis no especificada
Parent Concepts Scleral Diseases (C0036412), EYE LOCAL (C0549650), Scleritis or episcleritis NOS (C0339190), Endophthalmitis (C0014236), Scleritis (C0036416), Inflammation of specific body organs (C1285331)
Sources COSTAR, CST, DXP, ICD9CM, MSH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)

Nodular scleritis (C0339194)
Concepts Disease or Syndrome (T047)
English Nodular scleritis
Spanish escleritis nodular
Parent Concepts Anterior scleritis (C0155353)
Sources SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)

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