Ophthalmology Book

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ScleritisAka: Nodular Scleritis, Necrotizing Scleritis

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

Necrotizing Scleritis (C0027547)

ConceptsDisease or Syndrome (T047)
EnglishNecrotising scleritis, Necrotizing Scleritides, Necrotizing Scleritis
Spanishescleritis necrosante, escleritis necrotizante
Parent ConceptsScleritis (C0036416), Injury of anatomical site (C1264235)
SourcesMSH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Scleritis (C0036416)

Definition (MSH)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.
ConceptsDisease or Syndrome (T047)
ICD9379.00
EnglishScleritides, Scleritis, Unspecified scleritis
Spanishescleritis, escleritis no especificada
Parent ConceptsScleral Diseases (C0036412), EYE LOCAL (C0549650), Scleritis or episcleritis NOS (C0339190), Endophthalmitis (C0014236), Scleritis (C0036416), Inflammation of specific body organs (C1285331)
SourcesCOSTAR, CST, DXP, ICD9CM, MSH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Nodular scleritis (C0339194)

ConceptsDisease or Syndrome (T047)
EnglishNodular scleritis
Spanishescleritis nodular
Parent ConceptsAnterior scleritis (C0155353)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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