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    Early intervention considered key in diagnosis and treatment of scleritis

    Collaboration with rheumatologists key if biologics used for this sight-threatening disease

     

    Take-home message: Scleritis can indicate serious systemic disease and requires prompt diagnosis and treatment. Episcleritis also has certain treatment pearls.

     

    New Haven, CT—Scleritis requires an early and accurate diagnosis to help patients recover from this potentially sight- and life-threatening disease, said Vincent de Luise, MD, FACS.

    In case you missed it: treating pediatric atopic keratoconjunctivitis

    “We need to confront these cases confidently, diagnose them accurately, and provide prompt, correct intervention,” said de Luise, MD, FACS, assistant clinical professor of ophthalmology, Yale University School of Medicine, New Haven, CT.

    Scleritis is a painful, progressive disease characterized by inflammation and edema in the sclera and deep episclera. Corneal and external disease specialists are more likely than general ophthalmologists to see scleritis regularly. Scleritis is more common in females. In 50% of cases, it is idiopathic.

    “In the other 50%, there is an underlying systemic disease,” Dr. de Luise said.

    The underlying disease could be an immune-mediated systemic disease, and the strongest association is with vasculitis. Associated diseases include rheumatoid arthritis, Wegener’s granulomatosis, polyarteritis nodosa, and herpes zoster.

    In a quarter of the cases where there is underlying disease, the eye is the presenting sign.

    Infectious scleritis can present in many forms

    “In these cases, the eye is the barometer, and the initial sign of a potentially lethal disease,” Dr. de Luise said.

    Scleritis is almost always anterior, and it is classified as diffuse, nodular, necrotizing with inflammation, or necrotizing without inflammation. Posterior scleritis is rare and can mimic a choroidal tumor.

    Next: Making the distinction

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