Scleritis
Scleritis is a topic covered in the 5-Minute Clinical Consult.
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Basics
Description
- Scleritis is a painful, inflammatory process of the sclera, part of the eye’s outer coat.
- Categorized into anterior or posterior and diffuse, nodular, or necrotizing
- Commonly associated with systemic disorders
- Frequently requires systemic anti-inflammatory therapy
- Potentially vision threatening
- In contrast, episcleritis is a self-limited inflammation of the superficial episclera with only mild discomfort.
- System(s) affected: ocular
Epidemiology
- Mean age is 54 years (range 12 to 96).
- Predominant sex: female > male (1.6:1)
Incidence
Estimated to be 6 cases per 100,000 people in the general population
Etiology and Pathophysiology
- Frequently associated with a systemic illness (1)[B]
- Most commonly associated with rheumatoid arthritis
- In about 38% of cases, scleritis is the presenting manifestation of an underlying systemic disorder.
- Necrotizing scleritis has the highest association with systemic disease.
- Other etiologies
- Proposed pathogenesis is dependent on type of scleritis. In necrotizing scleritis, the predominant mechanism is likely due to the activity of matrix metalloproteinases.
- Drug-induced scleritis has been reported in patients on bisphosphonate therapy.
- Surgically induced necrotizing scleritis is exceedingly rare and occurs after multiple surgeries.
- Infectious scleritis occurs most commonly after surgical trauma, and Pseudomonas aeruginosa in poorly controlled diabetic patients is the most common causative organism (2)[B].
Risk Factors
Individuals with autoimmune disorders are most at risk.
Commonly Associated Conditions
- Rheumatoid arthritis (most common)
- Sjögren syndrome
- Granulomatosis with polyangiitis
- HLA-B27–associated ankylosing spondylitis
- Systemic lupus erythematosus
- Reactive arthritis
- Behçet disease
- Juvenile idiopathic arthritis
- Cogan disease
- Relapsing polychondritis
- Polyarteritis nodosa
- Sarcoidosis
- Inflammatory bowel disease
- Herpes zoster
- Herpes simplex
- HIV
- Syphilis
- Lyme disease
- Tuberculosis
- IgG4-related disease
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Citation
Stephens, Mark B., et al., editors. "Scleritis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. 5minute, www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116547/all/Scleritis.
Scleritis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116547/all/Scleritis. Accessed December 14, 2019.
Scleritis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116547/all/Scleritis
Scleritis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 December 14]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116547/all/Scleritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Scleritis
ID - 116547
ED - Stephens,Mark B,
ED - Golding,Jeremy,
ED - Baldor,Robert A,
ED - Domino,Frank J,
BT - 5-Minute Clinical Consult, Updating
UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116547/all/Scleritis
PB - Wolters Kluwer
ET - 27
DB - 5minute
DP - Unbound Medicine
ER -