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Chapter-35 Scleritis

BOOK TITLE: Uveitis: Text and Imaging

Author
1. Pavésio Carlos E
ISBN
9788184484915
DOI
10.5005/jp/books/11002_35
Edition
1/e
Publishing Year
2009
Pages
14
Author Affiliations
1. Moorfields Eye Hospital NHS Foundation Trust London, UK, Moorfields Eye Hospital, London, UK
Chapter keywords
Scleral disease, scleritis, episcleral disease, scleromalacia perforans, periocular pain, Necrotising scleritis, inflammatory bowel disease, Reiter’s syndrome, ankylosing spondylitis, diffuse anterior scleritis, photophobia

Abstract

This chapter provides an overview of scleritis. Scleral disease is probably much less common than episcleral disease, especially because the majority of episcleral inflammation goes unreported. Scleritis is bilateral in one third of the patients, the second eye becoming involved from three months to six years after the first. Scleritis is one of the very few severely painful eye diseases, and it is the most unbearable feature of the disease because it is not relieved by common analgesics. Pain is the predominant feature of scleral disease although it is sometimes almost absent in some patients with posterior scleritis and in scleromalacia perforans. The pain of scleral disease is usually described as a deep orbital pain or periocular pain affecting the periorbital bones. It typically wakes the patient up in the early hours of the morning and it is the only ocular disease in which this occurs. Tearing and photophobia are extremely rare, while diplopia can occur when the rectus muscles become involved, and it is more typically seen in posterior scleritis. The onset of scleral disease may be insidious. The patient becomes aware of headache or ocular discomfort, which may precede the redness of the eye by several days. Diffuse anterior scleritis is the commonest form occurring slightly more frequently in females. Associated systemic diseases include rheumatoid arthritis, the most frequent and also inflammatory bowel disease, Reiter’s syndrome and ankylosing spondylitis. The most usual presentation is that of a red eye. The redness may be generalised or localised to one quadrant. Nodular anterior scleritis is sometimes bilateral (25%) one eye usually being affected before the other. Necrotising scleritis is the most serious and the most destructive form of scleral disease. The patients are almost always older than those presenting with diffuse or nodular scleritis, the average age being sixty years. The condition is bilateral in 60% of the patients. Aching pain, particularly in the head, is usually the predominant feature, so intense that it seems out of proportion to the physical signs.

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