scleral disease

Scleritis: A Severe Ocular Inflammatory Condition

Scleritis is a rare and severe inflammatory condition that affects the sclera, the white outer layer of the eye. It can be categorized into two main types: anterior and posterior, each with subtypes such as diffuse, nodular, or necrotizing [2]. This condition can cause significant pain, inflammation, and vision loss if left untreated.

Characteristics of Scleritis

• Painful red eye: Scleritis is often characterized by a deep, boring ache in the affected eye, accompanied by photophobia (sensitivity to light) and tearing [4].
• Vision-threatening: The severity and presentation of scleritis can be visually significant, depending on the subtype and associated systemic conditions [2].
• Autoimmune disease: Scleritis is an autoimmune disease that affects the eye, causing inflammation and pain [3].

Types of Scleritis

• Anterior scleritis: This type affects the front part of the sclera and can be further classified into diffuse, nodular, or necrotizing subtypes.
• Posterior scleritis: This type affects the back part of the sclera and can also be categorized as diffuse or nodular.

Complications

Scleritis can lead to various complications, including:

• Vision loss: Untreated scleritis can cause permanent vision loss in one or both eyes.
• Systemic diseases: Scleritis is often associated with other autoimmune diseases such as rheumatoid arthritis, lupus, or Sjogren syndrome [11].
• Cardiovascular disease: Scleroderma, a related condition, can lead to cardiovascular disease, congestive heart failure, and immunodeficiency [14].

References

[1] - Context result 2 [2] - Context result 5 [3] - Context result 3 [4] - Context result 4 [11] - Context result 11

Based on the context, here are some signs and symptoms of scleral disease:

Common symptoms:

1. Eye pain or tenderness: Aching or sharp pain in the eye, which may radiate to the brow region or ear.
2. Redness and swelling of the sclera: The white part of the eye becomes red, swollen, and inflamed.
3. Blurred vision: Difficulty seeing clearly due to inflammation or scarring of the sclera.
4. Frequent tearing: Excessive lacrimation (tearing) may occur due to irritation or discomfort in the eye.
5. Sensitivity to light: Photophobia, or sensitivity to light, is a common symptom, which can be very painful.

Other symptoms:

1. Painful eye movements: Pain or tenderness when moving the eye or blinking.
2. Swollen eyelids: Swelling of the eyelids may occur due to inflammation or infection.
3. Discharge or pus: Yellowish discharge or pus may be present in the eye, especially if there's an underlying infection.

Rare but serious symptoms:

1. Vision loss: In severe cases, scleral disease can lead to permanent vision loss if left untreated.
2. Eye perforation: Rarely, the sclera can become so inflamed that it may rupture or perforate, leading to a serious eye emergency.

Keep in mind that these symptoms can vary depending on the underlying cause and severity of the scleral disease. If you suspect you have scleral disease, consult an eye care professional for proper diagnosis and treatment.

Diagnostic Tests for Scleral Disease

Scleral disease, including posterior scleritis and scleritis, can be challenging to diagnose due to its nonspecific symptoms. However, various diagnostic tests can aid in the diagnosis and management of these conditions.

• Imaging Studies: Imaging studies such as ultrasonography (A-scan and B-scan), orbital magnetic resonance imaging (MRI), and computed tomography (CT) scans are commonly used to diagnose posterior scleritis and scleritis. These tests help visualize the affected area and rule out other potential causes of symptoms [1, 2].
• Laboratory Tests: Laboratory tests such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), and serum uric acid levels can be used to identify underlying conditions that may be contributing to scleral disease. Additionally, antineutrophil cytoplasmic antibodies (ANCAs) may be tested to rule out granulomatosis with polyangiitis [3].
• Biopsy: In some cases, a biopsy of the affected area may be necessary to confirm the diagnosis and rule out other conditions such as infectious scleritis. Smears or biopsies are typically performed under local anesthesia [4].
• Blood Tests: Blood tests can be used to identify underlying conditions that may be contributing to scleral disease. These tests may include blood tests for rheumatoid factor, antinuclear antibodies (ANA), and other autoimmune markers [5].

References

[1] Hung J. Diagnostic procedures​​ B-scan ultrasonography and orbital magnetic resonance imaging (MRI) may be used for the detection of posterior scleritis.

[2] Lagina A. Common Lab Tests. Antineutrophil cytoplasmic antibodies (ANCAs) – specific for granulomatosis with polyangiitis.

[3] Diogo MC. MR imaging is the most useful examination in the diagnosis of scleritis, differentiating the sclera from the other ocular layers.

[4] CT or ultrasonography may be needed for posterior scleritis.

[5] EULAR and ACR diagnostic criteria for systemic sclerosis (SSc) were approved in 2013.

Based on the context, here are some potential answers to your question:

Topical treatments

1. Steroid eye drops (e.g., prednisolone acetate) to reduce inflammation and swelling.
2. Anti-inflammatory medications (e.g., NSAIDs) in the form of eye drops or ointments.

Oral medications

1. Corticosteroids (e.g., prednisone) to reduce inflammation and swelling systemically.
2. Immunosuppressive agents (e.g., cyclosporine, azathioprine) to modulate the immune response and prevent further inflammation.
3. Anti-inflammatory medications (e.g., NSAIDs) in oral form.

Other treatments

1. Pulse glucocorticoid therapy: high-dose corticosteroids given for a short period to rapidly reduce inflammation.
2. Tapering regimen: gradually reducing the dose of corticosteroids over time to minimize side effects.
3. Immunosuppressive therapy: using medications that suppress the immune system to prevent further inflammation.

Please note that these are general answers and may not be specific to your individual case. It's essential to consult with a healthcare professional for personalized advice on treating scleral disease.

Differential Diagnosis of Scleral Disease

Scleral disease, including conditions such as scleritis and episcleritis, can be challenging to diagnose due to their similar symptoms and overlapping clinical presentations. The differential diagnosis for scleral disease is broad and includes various ocular and systemic conditions.

Key Differential Diagnoses:

• Episcleritis: An inflammation limited to the episclera (the layer of tissue covering the white part of the eye), which can be confused with scleritis due to its similar symptoms.
• Conjunctivitis (Pink Eye): An inflammation of the conjunctiva, a thin membrane covering the white part of the eye and the inside of the eyelids, which can be mistaken for scleral disease.
• Allergic Conjunctivitis: A type of conjunctivitis caused by an allergic reaction, which can present with similar symptoms to scleritis.
• Herpes Zoster (Shingles): A viral infection that can cause inflammation and pain in the eye, which may be confused with scleral disease.

Other Differential Diagnoses:

• Ocular Rosacea: A chronic skin condition that can affect the eyes, causing inflammation and redness.
• Postoperative Corneal Melt: A complication of eye surgery that can cause inflammation and pain in the eye.
• Red Eye: A general term for any condition that causes redness and discomfort in the eye.

Systemic Conditions:

• Rheumatoid Arthritis: An autoimmune disease that can cause inflammation and pain in the joints, including the eyes.
• Lupus: An autoimmune disease that can affect various parts of the body, including the eyes.
• Inflammatory Bowel Disease (IBD): A condition that causes chronic inflammation in the digestive tract, which can be associated with eye problems.

References:

• [8] The most important differential diagnosis is between scleritis and episcleritis. Episcleritis is an inflammation limited to the episclera (the layer of tissue covering the white part of the eye), which can be confused with scleritis due to its similar symptoms.
• [9] It is essential to differentiate episcleritis from scleritis as management, prognosis, and complications differ for these diseases.
• [15] Although scleral disease is uncommon, prompt discrimination between episcleritis and scleritis is therapeutically important.