Scleritis (Inflammation of Sclera)

It is about scleritis. I try make it simple and sweet during my studies. Hope it would be beneficial for you too!

1. + Kamaruddin (PI
21+ June 2021

01589

2. SCLERITIS

a

Anterior Posterior &A

a use Nodular Nest

A (40 7 GA

With Without

inflammation [CP inflammation GA
Vaso-occlusive necrotizing scleritis
Granulomatous necrotizing scleritis

: + Scleromalacia perforans
Surgically induced necrotising séleritis (SINSY

Sainz de la Maza, M, Molina, N., Gonzalez-Gonzalez, L. A, Doctor, P.P., Tauber, J, & Foster, C.S. (2012). Clinical characteristics ofa large cohort of patients with scleritisand episcleritis. Ophthalmology, 119(2),
43-50. https://doi.org/10.1016/j ophtha.2011.07.013

3. SYMPTOMS

+ Severe & borin in - awake at night

+ Worsen with eye movement, with touch.
A May radiate ipsilateral to face, cheek & jaw.

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+ Gradual/acute onset red eye.
. Tearing, photophobia, decrease in vision.

+ Recurrent episode is common.

4. SIGNS

Scleral edema, intense + Tender & immobile

hyperemia

nodule

Bluish violaceous hue, Leeal/ dió

(observed in natural light)

Deep episcleral plexus
dilated

Scleral vessels do not

blanch vs episcleritis
(on application of Topical phenylephrine 2.57)

violaceous nodular

Thin, bluish

sclera

Necrotic/avascular
laques surrounded
Ey mildly dilated

episcleral vessels.

[nl Before drop phen

nderness wit!

E

lephrine, test for

cotton bud

5. Slit-beam view nodular Episcleritis vs. Scleritis

Aslit lamp section shows an underlying flat anterior
scleral surface, indicating the absence of scleritis.
Deep beam is not displaced above the scleral

Slit illumination shows superficial
displacement of the entire

beam
surface

6. ETIOLOGY

+ Associated systemic disease:
+ Rheumatoid arthritis (RAY
+ Granulomatosis with polyan itis (GPA)
+ Relapsing polychondritis (RP
+ Polyarteritis nodosa (PANY
+ Systemic lupus erythematosus (SLE\
. Ankylosing spondylitis (AS)
Inflammatory bowel disease (IBD)

. Infectious (e Herpes zoster, Syphilis, Tuberculosis)

+ Post surgery (i.e scleral buckling, pterygium surgery)

+ Trauma (ie penetrating injury contaminated by soil or vegetable)

7. INVESTIGATION

> B-scan: T-sian
(suggestive of olierion scleritis\

+ OCT
+ Fundus angiography

om optic nerve and fluid
enonis capsule

Hyporeflectivity fr
DT

+ Complete blood count (CBC)
+ ESR/CRP
+ Urine sediment

+ Serological tests:

o Rheumatoid factor (RA factor

o ANA (antinuclear antibodies)

o Anti ds DNA antibody

o ANCA (antineutrophil cytoplasmic antibodies)
o

VDRL, FTA-ABS

+ Chest X-ray
+ Tuberculin skin tests

8. POTENTIAL COMPLICATION

+ Scleral melt

+ Corneal melt

+ Anterior uveitis

A Cataract

+ Glaucoma

+ Exudative retinal detachment

. Staphyloma

9. TREATMENT

. Adequate control of the underlying condition.

. oystemic treatment:
Oral NSAID
Oral Prednisolone
Immunosuppressive therapy
Biologic immunomodulatory agents
Intravenous methylprednisolone

Alkylating agents

+ Surgical treatment:

Scleral grafting

Il Sclera to sclera grafti
hard: Common use anni
membrane grafting.

he
Le

Systemic (8 topical’

antimicrobials

ll Can start steroid as well
to control inflammation

Scleral debridement

Infectious
scleritis

10. PROGNOSIS

+ Nonnecrotizing noninfectious anterior
diffuse or no falar) scleritis :

Y Good prognosis with treatment

+ Necrotizing scleritis, posterior scleritis or
infectious lents :

+ High risk of permanent vision loss
La risk of higher mortality rates

11. $5) tirar, sin ee at

Nodular anterior scleritis / nodular non-necrotizing anterior scleritis

Necrotizing anterior scleritis without inflammation (Scleromalacia perforans)
Patient with rheumatoid arthritis. ‘Asymptomatic necrotic patch Moderate

‘and exposure of uvea

12. REFERENCES

* 2019-2020 BCSC (Basic and Clinical Science Course), Section 09:
Uveitis and Ocular Inflammation (MAJOR REVISION)

+ 2016. The Wills Eye Manual. 7th ed. Philadelphia, PA: Lippincott
Williams and Wilkins.