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Scleritis and Episcleritis


Presentation

  • In patients with episcleritis, decreased vision occurred in 2%, anterior uveitis was present in 11%, glaucoma developed in 4%, cataract formed in 2%, and specific disease association was uncovered in 32%.[ncbi.nlm.nih.gov]
  • PARTICIPANTS: Twenty subjects presenting clinical diseases compatible with episcleritis or scleritis. METHODS: Anterior segment ICG angiography was performed according to a standard protocol in subjects presenting either episcleritis or scleritis.[ncbi.nlm.nih.gov]
  • Note the malar rash that is also present. ( Courtesy of Richard P.[basicmedicalkey.com]
  • RESULTS: Eleven patients with a mean age of 49.5 years presented with symptomatic scleritis or episcleritis.[ncbi.nlm.nih.gov]
  • Management depends on the specific diagnosis, and every year a new list of potential associations or atypical presentations is reported. For a successful outcome, it is important that these presentations are recognized.[journals.lww.com]
Rigor
  • Scleritis - prevention There are no clear-cut preventative measures other than the rigorous control of the progression of any underlying disease and early treatment of the scleritis to minimise the risk of visual loss.[patient.info]
Red Eye
  • Red Eye Introduction 2 History Taking Red Eye Classification 2. Red Eye Diagnosis 9 Blepharitis Dry Eye Conjunctivitis Subconjunctival Haemorrhage Episcleritis And Scleritis Corneal Causes Of Red Eye Iritis Endophthalmitis Test Questions 3.[ophthalmologytraining.com]
  • February 07, 2018 / Tim Murphy Emergency physicians will see many patients presenting with a "red eye" throughout their career.[tamingthesru.com]
  • It causes a painful red eye and can affect vision, sometimes permanently. What's the difference between episcleritis and scleritis? Episcleritis and scleritis are mainly seen in adults.[dartonsurgery.nhs.uk]
  • Localised or diffuse red eye. Watering and occasional mild photophobia. No other associated ocular symptoms. No discharge other than watering. Visual acuity normal.[patient.info]
Eye Pain
  • Severe, boring eye pain often radiating to head and neck that worsens with eye movement.[basicmedicalkey.com]
  • Commonly associated symptoms of scleritis include redness of the sclera and conjunctiva, severe eye pain, photophobia (difficulty in looking at light) and tearing. It may lead to a decrease in visual acuity and blindness.[differencebetween.com]
  • Symptoms of Scleritis and Episcleritis A red or violet, slightly raised patch on the white of the eye, usually only a fraction of an inch in diameter Sharp, severe eye pain that intensifies when the eye is moved Dull, aching pain in one or both eyes,[healthcommunities.com]
  • Although clinical presentation was similar, with conjunctival injection noted in majority, eye pain and headache were more common with SC. Markers of inflammation were elevated in 7/15 SC and 6/15 EP.[acrabstracts.org]
  • pain over several days may radiate to surrounding facial areas may awaken the patient in the night (cf episcleritis) Tender on movement and palpation Usually not helped by analgesia Tearing may occur secondary to discomfort but discharge is uncommon.[dundeemedstudentnotes.wordpress.com]
Blurred Vision
  • vision Pain affecting the jaw or cranial bones around the eye Scleritis and Episcleritis Prevention There is no way to prevent episcleritis or scleritis.[healthcommunities.com]
  • Blurred vision and bland watering of the eye is seen due to inflammation of the tissues. A Red patch which may be slightly raised is commonly noted in cases of scleritis.[differencebetween.net]
  • Patients should be warned that phenylephrine will cause blurred vision and dilation of the pupil for approximately three hours. This test should not be done in patients with a history of glaucoma.[aafp.org]
  • The classic finding is interstitial keratitis, which causes redness, photophobia, pain, and blurred vision. Even though interstitial keratitis is a hallmark finding, it is not essential for diagnosis.[webeye.ophth.uiowa.edu]
  • Blurred vision was present in 45.2% of scleritis patients and 19.0% of episcleritis patients ( p 0.01). Ocular hypertension was present in 19.4% of scleritis patients, but was not present in any of the episcleritis patients ( p 0.01).[e-tjo.org]
Scleral Disease
  • Ocular Examination The ocular examination in scleral diseases must include an episcleral and scleral examination and a general ophthalmologic examination.[aao.org]
  • .), The Eye Center and The Eye Foundation for Research in Ophthalmology: Scleritis Episcleritis Optical coherence Tomography Additional relevant MeSH terms: Scleritis Scleral Diseases Eye Diseases[clinicaltrials.gov]
  • Similarly, oral mycophenolate mofetil (1 g twice daily) may be most useful as a steroid-sparing agent in patients with controlled scleral disease rather than as adjunctive therapy in patients with severe active scleritis requiring additional immunosuppressive[aao.org]
  • Meyer PA, Watson PG, Franks W, Dubord P: “Pulsed” immunosuppressive therapy in the treatment of immunologically induced corneal and scleral disease. Eye 1: 487, 1987. PubMed Google Scholar 12.[link.springer.com]
  • Progression of scleral disease . Ophthalmology. 1991 ;98: 467 – 471 . [Crossref] , [Web of Science ] , [Google Scholar] ]. 4.2. Tests Blood and radiographic tests are seldom helpful and are mainly used to diagnose associated autoimmune conditions.[tandfonline.com]
Blepharitis
  • Red Eye Diagnosis 9 Blepharitis Dry Eye Conjunctivitis Subconjunctival Haemorrhage Episcleritis And Scleritis Corneal Causes Of Red Eye Iritis Endophthalmitis Test Questions 3.[ophthalmologytraining.com]
  • Other conditions that have symptoms similar to scleritis include: episcleritis, which is an inflammation of superficial vessels in the outermost layer of the eye (episclera) blepharitis, which is an inflammation of the outer eye lid viral conjunctivitis[healthline.com]
  • Episcleritis frequently occurs in the setting of dry eye syndrome and blepharitis and attention to these two underlying issues is likely to be of benefit.[eyewiki.aao.org]
  • […] reactivation of SLE that was thought to be in remission. 16 External ocular manifestations include keratoconjunctivitis sicca, conjunctivitis, uveitis, episcleritis, scleritis, keratitis, and a discoid lupus rash over the eyelids that is often confused with blepharitis[aafp.org]
Malar Rash
Withdrawn
  • In our experience, the vast majority of chronic episcleritis is the result of having treated the condition initially with topical corticosteroids, and in this situation the condition will prove extremely difficult to treat if steroids are withdrawn.[entokey.com]

Workup

  • Designed for quick point-of-care reference, the book features numerous full-color photographs and bulleted how-to instructions for workup and treatment of each disorder.[books.google.com]
  • Workup Most episcleritis does not require a workup. Gather a careful review of systems (ROS) to rule out the very slight possibility that a patient’s episcleritis represents a forme fruste systemic autoimmune disease.[entokey.com]
  • Management Often a full systematic workup with blood tests and X rays may be required to exclude the potential underlying causes described above. Co-management with another physician (rheumatologist) may be advocated.[peterheyworth.com]
  • […] have some form of ocular inflammation whether you want to call it episcleritis, scleritis, uveitis or pan-uveitis - it all depends on the exact findings but all are similar in that they can have multiple possible causes and a properly directed medical workup[medhelp.org]
  • However, in recent years, there have been several reports of necrotizing scleritis occurring after pterygium surgery. [22], [23], [24], [25] In these case reports, none of the patients had an associated autoimmune disease, despite a complete systemic workup[e-tjo.org]

Treatment

  • CONCLUSIONS: Selective vs. non-selective COXIs were equally efficacious for the treatment of chronic non-infectious, non-necrotizing scleritis and episcleritis.[ncbi.nlm.nih.gov]
  • treatment 9.2 [3.0–28.7]) compared to the nonsmoking group.[nature.com]
  • Scleritis Scleritis almost always requires treatment with systemic medications.[aao.org]
  • Treatment of mild cases may include using artificial tears and cool compresses.[ibdrelief.com]
  • Treatment Scleritis: Scleritis needs treatment with non-steroid anti-inflammatory drugs and steroids. Episcleritis: Episcleritis is a self-limiting condition and often does not require any treatment.[differencebetween.com]

Prognosis

  • Prognosis Scleritis: Scleritis can have a bad prognosis. Episcleritis: With episcleritis prognosis is often good. Image Courtesy: “Scleritis” by Kribz – Own work.[differencebetween.com]
  • Scleritis - prognosis When scleritis originates from a systemic disorder, its course tends to follow that of the underlying problem.[patient.info]
  • Furthermore, smoking did not worsen the visual prognosis and was not associated with additional recurrences or ocular complications after successful treatment.[nature.com]
  • What is the long-term outlook (prognosis) for episcleritis and scleritis? Episcleritis does not usually have any significant long-term consequences unless it is associated with an underlying disease such as rheumatoid arthritis.[hershamsurgery.nhs.uk]

Etiology

  • Therefore, we conducted this study to evaluate and analyze our experience of the clinical features and etiologies of scleritis and episcleritis in Southern Taiwan. 2.[e-tjo.org]
  • Etiology and Pathophysiology Scleritis and episcleritis are inflammatory conditions causing congestion of the deeper 2 of the 3 vascular layers (conjunctival, episcleral, and scleral plexuses) overlying the avascular sclera.[basicmedicalkey.com]
  • Etiology: The most common underlying disorder for scleritis or episcleritis is rheumatic arthritis.[differencebetween.net]
  • Important considerations in the formulation of a therapeutic plan include accurate classification of scleritis type and identification of concomitant local or systemic disease, the exclusion of possible infectious etiologies, and the potential for medication[aao.org]
  • etiology include subacute/chronic complaints and absence of fever, infectious parameters, or sinusitis.[ajnr.org]

Epidemiology

  • METHODS:: Secondary analysis was performed on data from the Northern California Epidemiology of Uveitis Study.[jhu.pure.elsevier.com]
  • Epidemiology Scleritis usually presents between the ages of 30 and 50 years and is twice as common in women compared to men. 1 Forty-four percent of patients presenting with scleritis to specialty health centers were found to have an associated systematic[basicmedicalkey.com]
  • Furthermore, the results of our study need to be carefully interpreted because this data was based on a single hospital experience, which was not meant to represent the epidemiology of episcleritis and scleritis in the entire Taiwanese population.[e-tjo.org]
  • Many patients with nodular episcleritis have an associated systemic disease. [6] Epidemiology Diffuse episcleritis (84% of cases) is more common than nodular scleritis (16% of cases), and the mean age of all patients with episcleritis is 47.4 years. [[emedicine.medscape.com]
  • Types of Episcleritis: Diffuse episcleritis Nodular episcleritis Epidemiology: Common in females compared to males Common in young adults Etiology: Non-specific immune response to irritants Idiopathic (mostly) Rheumatoid arthritis (RA) Sjogren’s syndrome[epomedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • This article reviews the pathophysiology and clinical features of the different variants of episcleritis and scleritis, and also discusses current and emerging treatment modalities, including the biological agents and the putative role of periocular corticosteroid[eurekaselect.com]
  • Episcleritis Background Inflammation of the episclera (thin fibroelastic structure that lies between the conjunctiva and sclera) Usually mild and self-limiting Pathophysiology and aetiology Most cases are idiopathic Up to a third of patients have an underlying[dundeemedstudentnotes.wordpress.com]
  • Etiology and Pathophysiology Scleritis and episcleritis are inflammatory conditions causing congestion of the deeper 2 of the 3 vascular layers (conjunctival, episcleral, and scleral plexuses) overlying the avascular sclera.[basicmedicalkey.com]
  • Pingueculitis is used when the inflammation is centered on a pinguecula—this entity may represent a different pathophysiologic process than true episcleritis.[entokey.com]
  • Some cases may be caused by exogenous inflammatory stimuli. [3, 4, 5] Pathophysiology The pathophysiology is poorly understood.[emedicine.medscape.com]

Prevention

  • There is no way to prevent episcleritis or scleritis.[healthcommunities.com]
  • Prevention: There is no way one can prevent these diseases apart from cleanliness of the eye. The inflammation can only be reduced by application of local eye drops which have anti-inflammatory content in it.[differencebetween.net]
  • How do I prevent episcleritis and scleritis? These inflammatory conditions cannot be directly prevented.[hershamsurgery.nhs.uk]
  • Recognizing and appropriately treating scleritis are important not only to prevent such ocular morbidity but also to help diagnose and aid in the management of systemic autoimmune disease.[entokey.com]

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