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The British Journal of Ophthalmology Mar 1976The data from 159 patients (217 eyes) with episscleritis and 207 patients (301 eyes) with scleritis have been investigated in detail and the results analysed with the...
The data from 159 patients (217 eyes) with episscleritis and 207 patients (301 eyes) with scleritis have been investigated in detail and the results analysed with the help of a computer. Of these patients, 91 per cent were followed-up during a period of one to eight years. A new classification is presented which is as follows: Episcleritis (217 eyes) Simple episcleritis (170 eyes) Nodular episcleritis (47 eyes) Scleritis (301 eyes) Diffuse anterior scleritis (119 eyes) Nodular anterior scleritis (134 eyes) Necrotizing scleritis (42 eyes). Of these, 13 were regarded as scleromalacia perforans. Posterior scleritis (6 eyes) The diagnosis is based on an exact clinical examination which is fully described. Episcleritis has been shown to be a benign recurring condition, a mild keratitis being the only occasional complication. Episcleritis does not progress to scleritis, except in the case of herpes zoster which sometimes starts as an episcleritis with the vesicular stage of the eruption, to reappear three months later as a scleritis in the same site. No clear conclusions could be drawn as to the aetiology of episcleritis.
Topics: Adult; Age Factors; Aged; Cataract; Collagen Diseases; Conjunctivitis; Exophthalmos; Eye Diseases; Female; Glaucoma; Humans; Inflammation; Keratitis; Male; Middle Aged; Necrosis; Pain; Sclera; Sex Factors; Uveitis; Visual Acuity
PubMed: 1268179
DOI: 10.1136/bjo.60.3.163 -
Open Forum Infectious Diseases Jun 2018Scleritis is an inflammatory process involving the outer coating of the globe which is characterized by focal or diffuse hyperemia, moderate to severe pain, and frequent... (Review)
Review
Scleritis is an inflammatory process involving the outer coating of the globe which is characterized by focal or diffuse hyperemia, moderate to severe pain, and frequent impairment of vision. Most cases of scleritis are autoimmune in nature and are managed with topical and/or systemic corticosteroids. Infectious scleritis is a less common entity, occurring in 5%-10% of cases, and requiring directed antimicrobial therapy. We present a case of anterior nodular scleritis diagnosed via positive culture of an excisional biopsy of a scleral nodule. The patient improved after combined surgical and medical therapy with amoxicillin-clavulanate and moxifloxacin for 12 months. Based on a literature review, a summary of reported cases of infectious scleritis is provided, and guidelines pertaining to diagnosis and management are offered.
PubMed: 29977974
DOI: 10.1093/ofid/ofy140 -
BMC Ophthalmology Apr 2022To analyse demographic, clinical features, treatment and therapeutic outcomes of pediatric uveitis and scleritis patients.
BACKGROUND
To analyse demographic, clinical features, treatment and therapeutic outcomes of pediatric uveitis and scleritis patients.
SUBJECTS
The clinical records of pediatric uveitis and scleritis cases between January 2012 and December 2020 at a tertiary uveitis service center in Tianjin Medical University Eye Hospital (TMUEH) were reviewed.
RESULTS
In total, 209 patients (337 eyes) were included, 49.3% were male. The median onset age was 9.0 (IQR, 7.0-12.0) years. Chronic uveitis and scleritis accounted for 86.1%. Panuveitis (29.2%), anterior uveitis(29.2%), and intermediate uveitis (22.0%) were the most common presentations. The most common diagnoses were idiopathic (71.3%), JIA (8.1%), and infectious uveitis (4.8%). At baseline, 40.7% patients received oral corticosteroid therapy; during follow-up, corticosteroids (66.0%), disease-modifying antirheumatic drugs (61.2%), and biologic agents (35.4%) were the mainstay. Posterior synechia (26.1%) and cataracts (25.5%) were the most common complications. In acute cases, the median best corrected visual acuity (BCVA) was 0.99 (IQR, 0.5-1.0) at baseline and 0 (IQR, 0-0) at last follow-up; in chronic cases, the median BCVA improved from 1.09 (IQR, 0.5-2.0) to 0.27 (IQR, 0-0.5), with anterior chamber cell grade significantly declining. Ten eyes underwent cataract surgery during regular follow-up and achieved satisfactory long-term visual outcomes and decreased burden of immunosuppressants. The incidence of steroid-induced ocular hypertension was 41.0%, and children with frequent instillation of eyedrops were at high risk.
CONCLUSIONS
Most cases were of chronic uveitis and scleritis requiring long-term systemic immunosuppressive therapies in pediatric uveitis and scleritis in China. Good management of complications is important for long-term prognosis.
Topics: Child; Demography; Female; Humans; Male; Retrospective Studies; Scleritis; Tertiary Care Centers; Uveitis; Visual Acuity
PubMed: 35436862
DOI: 10.1186/s12886-022-02404-z -
Journal of Translational Medicine Jun 2023Uveitis and posterior scleritis are sight-threatening diseases with undefined pathogenesis and accurate diagnosis remains challenging.
BACKGROUND
Uveitis and posterior scleritis are sight-threatening diseases with undefined pathogenesis and accurate diagnosis remains challenging.
METHODS
Two plasma-derived extracellular vesicle (EV) subpopulations, small and large EVs, obtained from patients with ankylosing spondylitis-related uveitis, Behcet's disease uveitis, Vogt-Koyanagi-Harada syndrome, and posterior scleritis were subjected to proteomics analysis alongside plasma using SWATH-MS. A comprehensive bioinformatics analysis was performed on the proteomic profiles of sEVs, lEVs, and plasma. Candidate biomarkers were validated in a new cohort using ELISA. Pearson correlation analysis was performed to analyze the relationship between clinical parameters and proteomic data. Connectivity map database was used to predict therapeutic agents.
RESULTS
In total, 3,668 proteins were identified and over 3000 proteins were quantified from 278 samples. When comparing diseased group to healthy control, the proteomic profiles of the two EV subgroups were more correlated with disease than plasma. Comprehensive bioinformatics analysis highlighted potential pathogenic mechanisms for these diseases. Potential biomarker panels for four diseases were identified and validated. We found a negative correlation between plasma endothelin-converting enzyme 1 level and mean retinal thickness. Potential therapeutic drugs were proposed, and their targets were identified.
CONCLUSIONS
This study provides a proteomic landscape of plasma and EVs involved in ankylosing spondylitis-related uveitis, Behcet's disease uveitis, Vogt-Koyanagi-Harada syndrome, and posterior scleritis, offers insights into disease pathogenesis, identifies valuable biomarker candidates, and proposes promising therapeutic agents.
Topics: Humans; Behcet Syndrome; Uveomeningoencephalitic Syndrome; Scleritis; Spondylitis, Ankylosing; Proteomics; Uveitis; Extracellular Vesicles
PubMed: 37322475
DOI: 10.1186/s12967-023-04228-x -
Annals of Translational Medicine Nov 2022To analyze the clinical characteristics and long-term treatment outcomes of patients with posterior scleritis.
BACKGROUND
To analyze the clinical characteristics and long-term treatment outcomes of patients with posterior scleritis.
METHODS
This retrospective, observational case series analyzed medical records of 14 patients diagnosed with infectious or non-infectious posterior scleritis between May 2005 and March 2020 at Severance Hospital and Gangnam Severance Hospital.
RESULTS
A total of 12 patients with non-infectious and two with infectious posterior scleritis were treated. Conjunctival injection (85.7%) was the most common symptom, followed by pain on eyeball movement (57.1%), and decreased visual acuity (42.9%). Anterior uveitis (64.3%) was the most common associated clinical finding. In five eyes (35.7%), immunosuppressive agents were administered in addition to corticosteroids to control the inflammation. Recurrence was noted in three eyes (21.4%), all of them showing non-infectious scleritis. The final visual acuity of the patients did not show significant change compared to that at the first visit (P=0.878).
CONCLUSIONS
Most posterior scleritis patients were of non-infectious type and some needed additional immunosuppressive treatment. In patients with a history of ocular surgery or trauma, especially with the presence of pus-containing nodules, infectious posterior scleritis should always be considered. Since impaired vision does not improve significantly after treatment of posterior scleritis, prompt diagnosis and aggressive treatment are recommended.
PubMed: 36467362
DOI: 10.21037/atm-22-721 -
Revue Medicale de Liege Jul 2016Posterior scleritis, a severe and painful inflammation of the sclera, is an often misdiagnosed pathology due to its clinical polymorphism. An accurate diagnosis is...
Posterior scleritis, a severe and painful inflammation of the sclera, is an often misdiagnosed pathology due to its clinical polymorphism. An accurate diagnosis is however needed in order to propose an appropriate treatment of the ophthalmologic symptoms and to exclude an associated systemic inflammatory or auto-immune pathology.
Topics: Diagnosis, Differential; Diplopia; Female; Fluorescein Angiography; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Scleritis
PubMed: 28383839
DOI: No ID Found -
TheScientificWorldJournal 2015Though inflammatory bowel disease (IBD) has a specific predilection for the intestinal tract, it is a systemic inflammatory disorder affecting multiple organs, including... (Review)
Review
Though inflammatory bowel disease (IBD) has a specific predilection for the intestinal tract, it is a systemic inflammatory disorder affecting multiple organs, including the eye. Ocular complications directly related to IBD are categorized as primary and secondary. Primary complications are usually temporally associated with IBD exacerbations and tend to resolve with systemic treatment of the intestinal inflammation. These include keratopathy, episcleritis, and scleritis. Secondary complications arise from primary complications. Examples include cataract formation due to treatment with corticosteroids, scleromalacia due to scleritis, and dry eye due to hypovitaminosis A following gut resection. Some ocular manifestations of IBD can lead to significant visual morbidity and temporally associated complications can also be a herald of disease control. Furthermore, ocular manifestations of IBD can occasionally manifest before the usual intestinal manifestations, leading to an earlier diagnosis. Thus, it is important to understand the clinical presentation of possible ocular manifestations in order to initiate appropriate treatment and to help prevent significant visual morbidity.
Topics: Adrenal Cortex Hormones; Animals; Dry Eye Syndromes; Eye Diseases; Humans; Inflammatory Bowel Diseases; Scleritis
PubMed: 25879056
DOI: 10.1155/2015/438402 -
Ophthalmologica. Journal International... 2023Vasculitis is a group of diseases characterized by the inflammation of the blood vessel walls. They are classified according to the size of the main vessel involved:... (Review)
Review
Vasculitis is a group of diseases characterized by the inflammation of the blood vessel walls. They are classified according to the size of the main vessel involved: large vessel, medium vessel, and small vessel vasculitis. Ophthalmic manifestations are quite common in most of these diseases. Episcleritis and scleritis are the most prevalent manifestation of vasculitis. However, there are certain ocular features characteristic of specific vasculitis entities. Given the severity and potential life-threat of these diseases, knowledge of the ocular manifestations is mandatory for the ophthalmologists.
Topics: Humans; Eye; Scleritis; Vasculitis; Inflammation; Systemic Vasculitis; Eye Diseases
PubMed: 37331330
DOI: 10.1159/000531395 -
Cleveland Clinic Journal of Medicine Nov 2012Ophthalmic manifestations of vasculitis can be orbital, ocular (affecting the globe), or intraocular. Orbital inflammation manifests as sudden onset of pain, erythema,... (Review)
Review
Ophthalmic manifestations of vasculitis can be orbital, ocular (affecting the globe), or intraocular. Orbital inflammation manifests as sudden onset of pain, erythema, and proptosis, and can be sight-threatening. In the globe, red eye is typical in both episcleritis and scleritis. Episcleritis is usually otherwise asymptomatic with blanching upon instillation of topical phenylephrine, whereas scleritis is painful and does not blanch. Infectious and rheumatic diseases are present in nearly 50% of patients with scleritis. The symptoms of keratitis are similar to those of scleritis; superficial keratitis is benign but peripheral ulcerative keratitis can be sight-threatening. Anterior uveitis is the most frequent ocular manifestation of Behçet disease. Approximately 30% of patients with granulomatosis with polyangiitis (Wegener's granulomatosis) have ocular involvement, with orbital disease being most common. With ophthalmic manifestations of vasculitis, tissue biopsy of any site that is amenable to biopsy is recommended. Biopsy must be interpreted within the context of treatment.
Topics: Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Eye Diseases; Humans; Orbital Diseases; Scleritis
PubMed: 23203643
DOI: 10.3949/ccjm.79.s3.07 -
Clinical and Experimental Rheumatology May 2022Relapsing polychondritis (RP) evolves with variable and intermittent involvement of cartilage and proteoglycan-rich structures. Ocular manifestations are present in up... (Review)
Review
OBJECTIVES
Relapsing polychondritis (RP) evolves with variable and intermittent involvement of cartilage and proteoglycan-rich structures. Ocular manifestations are present in up to two-thirds of RP patients. Necrotising scleritis (NS) and peripheral ulcerative keratitis (PUK) may be inaugural and may lead to eye perforation and vision loss. We aimed to review NS and PUK in RP, in order to characterise them, to identify successful treatment options and unmet needs.
METHODS
A systematic review of the currently available evidence in PubMed, EMBASE and Scopus was performed according to PRISMA, including observational studies, single case reports and case series of NS/PUK in RP. Study design, number of patients, age, gender, treatment and outcome, were extracted. Two RP patients also provided their opinion.
RESULTS
Five case reports and two case series were eligible for inclusion. We identified 10 RP patients with eye-threatening complications (NS and/or PUK), 9 adults (2 males, 7 females, aged 35-72, median age 57.6 years) and one paediatric patient (F, 11 years). Apart from glucocorticoids, cyclophosphamide was effective in 4 patients; infliximab, high-dose immunoglobulins, dapsone, or cyclosporine were also successfully employed in a case each. Surgical repair was reported in 2 cases.
CONCLUSIONS
Ocular inflammation is often bilateral and recurring in RP; NS/PUK are rare complications. All patients who develop NS/PUK should be specifically questioned for RP signs and symptoms. Early institution of immunosuppressive therapies is mandatory. Increasing awareness, physicians' and patients' education and a multidisciplinary approach may help improve the prognosis of these serious complications of RP.
Topics: Adult; Child; Corneal Ulcer; Cyclophosphamide; Female; Humans; Infliximab; Male; Middle Aged; Polychondritis, Relapsing; Scleritis
PubMed: 35238768
DOI: 10.55563/clinexprheumatol/27n7im