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Scleromalacia Perforans


Presentation

  • She presented to us with pronounced eye manifestation which on further inquiry and investigation was found to be associated with rheumatoid arthritis. There was perforation of left globe on presentation and the right one was preserved.[ncbi.nlm.nih.gov]
  • Medical answers. // Arthritis Today;Jan/Feb92, Vol. 6 Issue 1, p56 Presents answers to questions on arthritis.[connection.ebscohost.com]
  • Abstract Postoperative endophthalmitis may present in an atypical fashion (absent or minimal anterior chamber reaction) in the presence of underlying immunosuppressive disorder.[ncbi.nlm.nih.gov]
  • It may be present at the time of diagnosis or infact may be the presenting feature in 8% to 16% of patients [1] - [8] .[ncbi.nlm.nih.gov]
  • Necrotizing scleritis without inflammation, also known as scleromalacia perforans, is a very rare form of scleritis presenting with no symptoms.[zgthpbcc.gq]
Prolonged Immobilization
  • However, since one of the patient's legs was already in a cast from spontaneous Achilles tendon rupture and she had severe rheumatoid lung disease and difficulty ambulating, prolonged immobilization after harvesting periosteum or fascia lata was not considered[healio.com]
Pleural Effusion
  • effusion, and rheumatoid nodules, has been noted in patients with rheumatoid scleritis.[healio.com]
Halitosis
  • Left eye showing scleral thinning in the upper nasal quadrant with visible uveal tissue(thick arrow) and peripheral corneal thinning in the upper and lower part of limbus(thin arrow) Halitosis and saddle nose deformity were noted.[ncbi.nlm.nih.gov]
Hypertension
  • She developed steroid induced diabetes and hypertension in September 1993, and she was treated with oral hypoglycemic and anti hypertensive agents. Cyclophosphamide and prednisolone were tapered slowly and stopped in June 1999.[ncbi.nlm.nih.gov]
  • Anterior Chamber Brain and Optical Pathway Choroid Congenital Syndromes, Malformations and Abnomalities Conjunctiva Cornea Glaucomas, Ocular Hypertension Hypertensive Retinopathy Iris and Ciliary Body Lacrimal System Lens Lids Neuro-Ophthalmology Optic[atlasophthalmology.net]
  • Statistical attributes of the steroid hypertensive response in the clinically normal eye. I. The demonstration of three levels of response. Invest Ophthalmol Vis Sci. 1965 Apr;4:187-97.[reviewofoptometry.com]
  • She had been treated for hypertension and coronary artery disease for seven years and osteoarthritis for 20 years. Her best-corrected visual acuity was 6/36 in the right eye and 6/15 in the left eye.[ijo.in]
  • […] polychondritis [12] Sarcoidosis Inflammatory bowel disease Sjögren syndrome Additional causes of scleritis include the following: Syphilis [13] Post herpes zoster ophthalmicus Poststreptococcal syndrome [14] Tuberculosis Gout Lyme disease Foreign body Hypertension[emedicine.medscape.com]
Excitement
  • Till recently the disease seemed to drag on indefinitely without doing much damage or exciting many symptoms. But if a fistulization occured a flap operation was indicated.[myslide.es]

Workup

  • Diagnosis, Workup and Treatment Further investigation into the patient’s ocular history found that he had undergone the I-Brite eye-whitening procedure four years prior to presentation.[reviewofophthalmology.com]
  • Laboratory test As scleritis may occur in association with many systemic diseases, laboratory workup may be extensive.[eyewiki.aao.org]
  • GPA is often overlooked due to its rare incidence—just three cases per 100,000 people. 3 Approximately 10% of patients with GPA develop scleritis, so ANCA testing should be included in the workup of these patients. 4 In addition to GPA, rheumatoid arthritis[reviewofoptometry.com]
Neisseria Gonorrhoeae
  • Log In Forgot password Forgot email Related Bacterial keratitis Image Pressure patch Image Neisseria gonorrhoeae Image Lacrimal System Disorders Image Differential diagnosis of red eye Image Most Commented Loading, please wait...[aao.org]
Granulomatous Tissue
  • Computed tomography (CT) scan of the orbits showed proptosis of left eye with retrobulbar infiltration of granulomatous tissue and vitreous haemorrhage ( Figure 4 ).[ncbi.nlm.nih.gov]
Pleural Effusion
  • effusion, and rheumatoid nodules, has been noted in patients with rheumatoid scleritis.[healio.com]

Treatment

  • […] from Long-Standing Bulbar Conjunctival Rhinosporidiosis. ( 27342330 ) Bothra N....Tripathy D. 2016 3 Bilateral scleromalacia perforans and peripheral corneal thinning in Wegener's granulomatosis. ( 22553696 ) Reddy S.C....Rohana T. 2011 4 Infliximab treatment[malacards.org]
  • […] from Long-Standing Bulbar Conjunctival Rhinosporidiosis. ( 27342330 ) Bothra N....Tripathy D. 2016 4 Bilateral scleromalacia perforans and peripheral corneal thinning in Wegener's granulomatosis. ( 22553696 ) Reddy S.C....Rohana T. 2011 5 Infliximab treatment[malacards.org]
  • Treatment of Scleromalacia Perforans The usual treatment of Scleromalacia Perforans includes the use of both the topical and systemic medications.[webeyeclinic.com]
  • Rheumatoid nodules mimicking metastatic anal carcinoma in a patient undergoing multimodality treatment.[connection.ebscohost.com]
  • The treatment of scleromalacia perforans can be either medical or surgical.[docslide.com.br]

Prognosis

  • Treatment and prognosis The condition is usually asymptomatic. Rupture of the globe is rare and usually only seen in those with coexisting markedly elevated intraocular pressure, i.e. severe glaucoma 1 .[radiopaedia.org]
  • Prognosis and Outcomes Scleromalacia Perforans has a good outcome provided the condition is diagnosed at an early stage and treatment started before any complication arises.[webeyeclinic.com]
  • It is a diffuse and virulent scleritis with a very bad prognosis. Duke-Elder describes it in his excellent textbook T.[myslide.es]
  • Erhardt CC et al . (1989) Factors predicting a poor life prognosis in rheumatoid arthritis: an eight year prospective study . Ann Rheum Dis 48 : 7–13 31.[nature.com]
  • Prognosis Necrotizing scleritis, the most destructive type of scleritis, and scleritis with extensive scleral thinning or perforation convey less favorable prognoses than other types of scleritis.[emedicine.medscape.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • The etiology is obscure. An area in the sclera first undergoes a simple necrosis. This area is surrended by epitheloid cells.[myslide.es]
  • In our case, our patient was treated initially as an infective etiology and lost one eye quickly during the course of the disease. Other common complications include scleral thinning and globe rupture with minor trauma [ 14 ].[ncbi.nlm.nih.gov]

Epidemiology

  • ., Epidemiology and visual outcomes in patients with infectious scleritis, Cornea , 2013;32:466–72. 6.[touchophthalmology.com]
  • Tuberculosis Gout Lyme disease Foreign body Hypertension Surgically-induced scleritis is a rare complication following ophthalmologic procedures such as the following: Cataract surgery Pterygium excision Strabismus surgery Retinal detachment repair.ref16} Epidemiology[emedicine.medscape.com]
  • Thus, infectious etiologies should be suspected in any case of progressive indolent necrosis with suppuration, refractory to anti-inflammatory regimens ( see Figure 4 ). 22 2013, our institution reported the epidemiology and outcomes of all patients with[touchophthalmology.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology As there are different forms of scleritis, the pathophysiology is also varied. Scleritis associated with autoimmune disease is characterized by zonal necrosis of the sclera surrounded by granulomatous inflammation and vasculitis.[eyewiki.aao.org]
  • Pathophysiology The sclera, which consists of collagen and elastic connective tissue, provides a tough protective casing around the eye.[emedicine.medscape.com]

Prevention

  • Glaucoma implant surgery using autogenous fascia lata to form a healthy ground and a patch graft to prevent tube erosion seems to be a safe and effective method when normal sclera is lacking, such as in scleromalacia perforans.[ncbi.nlm.nih.gov]
  • Avoidable - 0% Emergent - ED Care Needed - Not Preventable/Avoidable - 0% Primary diagnosis of injury 0% Primary diagnosis of mental health problems 0% Primary diagnosis of substance abuse 0% Primary diagnosis of Alcohol 0% Unclassified 100% Health Topic[codelay.com]
  • M.D.C MDC Category Not Assigned For This ICD Code H15.05 Medicare Severity-Diagnosis Related Groups MS-DRG MS-DRG Category Not Assigned For This ICD Code H15.05 Clinical Classifications Software CCS CCS Category Not Assigned For This ICD Code H15.05 Prevention[codelay.com]

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