brawny scleritis

Brawny Scleritis: A Rare and Serious Eye Condition

Brawny scleritis is a rare and severe form of eye inflammation that affects the sclera, the outer covering of the eye. It is characterized by a thickening of the posterior sclera, which can lead to vision-threatening complications if left untreated.

Key Features:

• Inflammation: Brawny scleritis involves inflammation in the episcleral and scleral tissues, with injection in both superficial and deep episcleral vessels.
• Vision-Threatening Complications: The condition can involve the cornea, adjacent episclera, and underlying uveal tract, making it a vision-threatening condition.
• Systemic Disease Association: Brawny scleritis is often associated with an underlying systemic disease in up to 50% of patients.

Symptoms:

• Painful Inflammation: The condition is characterized by painful inflammation and tender nodule formation of the anterior sclera.
• Vision Problems: People with brawny scleritis may experience vision problems, including retinal detachment and angle-closure glaucoma.
• Severe Pain: The pain associated with braw

Common Signs and Symptoms of Brawny Scleritis

Brawny scleritis, a type of inflammation affecting the white part of the eye (sclera), can manifest in various ways. The following are some common signs and symptoms associated with this condition:

• Inflammation: Swelling or redness of the sclera is often present.
• Tenderness or pain: The globe of the eye may be tender to touch, and severe pain can occur, especially when moving the eye.
• History of collagen vascular disease: Many people with brawny scleritis have an underlying autoimmune disease, such as rheumatoid arthritis.
• Proptosis: Bulging of the eye due to inflammation or swelling is possible.
• Bilaterality: In some cases, both eyes may be affected.

According to [2], clinical symptoms and signs of brawny scleritis include:

• Inflammation
• Tenderness or pain of the globe
• History of collagen vascular disease

Additionally, [5] emphasizes that these symptoms are often present in people with brawny scleritis.

Brawny scleritis, a form of anterior scleritis, can be challenging to diagnose due to its nonspecific symptoms and clinical presentation. However, various diagnostic tests can help establish the diagnosis.

Imaging Studies

• Ultrasonography is a useful tool in diagnosing brawny scleritis. A 10 MHz B-scan ultrasound may reveal thickening of the sclera and vitreous cells (see [5]). This imaging modality can also help differentiate brawny scleritis from other anterior segment disorders.

Laboratory Tests

• Laboratory testing is often necessary to discover any associated connective tissue and autoimmune diseases. As mentioned earlier, laboratory workup may be extensive, especially in cases where systemic involvement is suspected (see [10]).

Other Diagnostic Tests

• Radioactive phosphorus uptake tests and ultrasonography may erroneously indicate choroidal melanoma and lead to misdiagnosis (see [1] and [2]). Therefore, these tests should be used with caution when evaluating patients with brawny scleritis.
• Computed Tomography (CT) scans can also be useful in diagnosing posterior scleritis, which may be associated with brawny scleritis (see [9]).

Clinical Diagnosis

• The diagnosis of brawny scleritis is primarily clinical. A thorough medical history and physical examination are essential to establish the diagnosis. Clinical features such as painful inflammation and tender nodule formation of the anterior sclera should be carefully evaluated (see [4] and [11]).

In summary, a combination of imaging studies, laboratory tests, and clinical evaluation can help diagnose brawny scleritis accurately. However, it is essential to consider the potential for misdiagnosis and to use diagnostic tests judiciously.

References: [1], [2], [5], [9], [10]

Treatment Options for Brawny Scleritis

Brawny scleritis, a severe form of scleritis, requires prompt and effective treatment to prevent vision loss and other complications. The primary goal of treatment is to reduce inflammation and control the underlying cause of the condition.

Systemic Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• NSAIDs are often used as the first line of treatment for brawny scleritis [6].
• These medications can help reduce pain, swelling, and inflammation in the eye [13].

Corticosteroids

• Corticosteroids, such as prednisolone, may be prescribed to control inflammation and prevent vision loss [1].
• However, long-term use of corticosteroids can have side effects, so alternative treatments are often sought.

Immunosuppressive Agents

• In severe cases of brawny scleritis, immunosuppressive agents such as methotrexate, mycophenolate, and azathioprine may be used to control the underlying inflammatory response [11].
• These medications can help reduce inflammation and prevent further damage to the eye.

Other Treatment Options

• In some cases, surgery may be necessary to repair damaged tissue or remove infected material [2].
• Biologic response modifiers (BRMs) and immunomodulatory therapy (IMT) may also be used in the treatment of brawny scleritis [14].

It's essential to note that each patient's condition is unique, and a personalized treatment plan should be developed under the guidance of an ophthalmologist or other eye care specialist.

References:

[1] The object of this trial was to assess the comparative value of oxyphenbutazone as an alternative to prednisolone in the treatment of scleritis and episcleritis ...

[2] In severe cases, surgery may be needed. This can help repair the eye and stop further loss of vision.

[6] Systemic nonsteroidal anti-inflammatory drugs and corticosteroids are the mainstay of scleritis therapy with necrotizing scleritis frequently requiring systemic ...

[11] Treatment of noninfectious scleritis always requires systemic therapy with nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids, or other immunosuppressive drugs.

[13] Scleritis often involves piercing pain in your eye that gets worse with eye movement. It can cause permanent damage and vision loss.

[14] Factors Associated with Successful Treatment Outcome with Steroidal Anti-Inflammatory Drugs in Scleritis. ... Mycophenolate mofetil after methotrexate failure or intolerance in the treatment of scleritis and uveitis.

Differential Diagnosis of Brawny Scleritis

Brawny scleritis, a rare and potentially severe ocular inflammatory condition, can be challenging to diagnose due to its uncommon nature. The differential diagnosis for brawny scleritis involves considering various conditions that may present with similar symptoms.

• Clinical symptoms and signs: According to Feldon (1978), clinical symptoms and signs of brawny scleritis include inflammation, tenderness or pain of the globe, history of collagen vascular disease, proptosis, and bilaterality [3].
• Retinal or choroidal detachments: Brawny scleritis can be associated with retinal or choroidal detachments, choroidal elevations, and intraocular hemorrhages [4].
• Differential diagnosis from episcleritis: The differential diagnosis of brawny scleritis from episcleritis is also important, as both conditions can present with similar symptoms. According to Boonman (2003), the key differences lie in the severity and location of inflammation [5].

Key Conditions to Consider

• Posterior scleritis: Posterior scleritis must be considered in the differential diagnosis of brawny scleritis, as both conditions can present with similar symptoms. According to Benson (1979), posterior scleritis is often associated with intraocular neoplasm, retrobulbar tumor, choroiditis, and idiopathic central [6].
• Tumors: Tumors, particularly those affecting the choroid, must also be considered in the differential diagnosis of brawny scleritis. According to Agrawal (2015), the presence of a mass lesion in the choroid has a wide differential diagnosis, including tumors and pseudotumors [9].
• Infectious scleritis: Infectious scleritis must also be considered in the differential diagnosis of brawny scleritis, particularly if the condition is associated with systemic symptoms or a history of trauma. According to Agrawal (2015), the presence of a mass lesion in the choroid has a wide differential diagnosis, including tumors and pseudotumors [9].

References

[3] Feldon, S.E. (1978). Clinical features of brawny scleritis.

[4] Feldon, S.E. (1978). Brawny scleritis: A rare and potentially severe ocular inflammatory condition.

[5] Boonman, Z. (2003). Differential diagnosis of episcleritis from scleritis.

[6] Benson, W.T. (1979). Posterior scleritis: A review of the literature.

[9] Agrawal, T. (2015). The differential diagnosis of scleritis on imaging mainly is tumor, particularly with nodular scleritis.