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PubMed1988

Ultrastructural changes in scleral proteoglycans precede destruction of the collagen fibril matrix in necrotizing scleritis.

Proteoglycans were localized using cuprolinic blue and visualized by electron microscopy in sclera from the eye of a 58-year-old woman with necrotizing scleritis. Samples of sclera taken from clinically normal anterior and posterior sclera and from sites involved in anterior necrotizing scleritis with ulceration and posterior scleritis showed markedly different patterns of proteoglycan distribution. Proteoglycans appeared as stain-positive filaments associated regularly with the 'd/e' bands of the collagen fibrils in normal anterior sclera, but were absent from intact collagen fibrils in the zone of anterior ulcerative scleritis. In posterior sclera including a site of posterior scleritis, proteoglycans were reduced in number with more heterogeneous associations with collagen fibrils. Depletion of scleral proteoglycans therefore precedes the degradation of scleral collagen in necrotizing scleritis, which may also involve the synthesis of atypical proteoglycan types in pathological sclera.

Adult↗

PubMed1977

Corneal sensation in scleritis and episcleritis.

A series of 59 patients were examined for loss of corneal sensitivity. Thirty-five of them suffered from scleritis and 24 suffered from episcleritis. There was a difference between the 2 conditions in that significantly more patients with scleritis were affected than patients with episcleritis. It was also found that among the scleritis patients there was a close relationship between the number of quadrants affected and decrease in sensitivity. Five patients had necrotising scleritis, and they all showed marked loss of sensitivity. Sensitivity returned to normal when the scleritis resolved except when a large area of scleral ectasia resulted. The test is of importance because it is one of the easiest methods of detecting the onset of necrotising scleritis in its earliest stages.

Cornea↗

PubMed1993

Infectious scleritis: report of four cases.

While systemic autoimmune diseases are the main possibilities in the differential diagnosis of scleritis, other less common etiologies such as infections must also be considered. The authors report four cases of infectious scleritis to review predisposing factors, clinical characteristics, methods of diagnostic approach, and response to therapy. Two patients had primary scleritis and two patients had secondary scleritis following extension of primary corneal infection (corneoscleritis). Diagnoses included three local infections (one each with Staphylococcus. Acanthamoeba, and herpes simplex) and one systemic infection (Lyme disease). Stains, cultures, or immunologic studies from scleral, conjunctival, and/or corneal tissues, and serologic tests were used to make the diagnosis. Medical therapy, including antimicrobial agents, was instituted in all patients, and surgical procedures were additionally required in two patients (scleral grafting in one and two penetrating keratoplasties in another); the patient who required two penetrating keratoplasties had corneoscleritis and underwent eventual enucleation. Infectious agents should be considered in the differential diagnosis of scleritis.

Amebiasis↗

PubMed2005

Celecoxib, a selective inhibitor of cyclooxygenase 2 for therapy of diffuse anterior scleritis.

PURPOSE: Scleritis is a painful inflammation of the sclera that is often difficult to treat. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective. Results of treating 24 cases of diffuse anterior scleritis with the novel selective COX-2 inhibitor celecoxib are reported. DESIGN: Nonrandomized prospective study. METHODS: Twenty-four patients suffering from diffuse anterior scleritis were seen in the Interdisciplinary Uveitis Center in Heidelberg between April 2001 and April 2003. All patients were treated with a 200- to-800 mg dose of celecoxib per day, in divided doses, depending on the degree of discomfort and clinical severity. RESULTS: Twenty-two patients experienced significant clinical improvement within an average of 5 days of starting celecoxib. These patients reported a complete loss of pain and scleral redness. As they experienced complete symptomatic remission, the dose of celecoxib was tapered. Three of these patients suffered from a second attack of scleritis, with one patient requiring long-term low-dose therapy, one patient showing a nodular form, and the third showing no improvement. Treatment with celecoxib was associated with no side effects apart from allergic exanthema in two patients. CONCLUSION: Due to its anti-inflammatory potency and low rate of side effects, celecoxib is an effective drug for the treatment of diffuse anterior scleritis. Compared with other NSAIDs it shows minimal gastrointestinal side effects, so its high cost is justified. It represents an alternative drug therapy before systemic immunosuppressive treatment.

Adult↗

PubMed2006

[Interest of cotrimoxazole in relapsing idiopathic anterior scleritis: about six cases].

INTRODUCTION: Anterior scleritis is defined as an inflammation of the sclera, located anteriorly to the equator of the eye. Cotrimoxazole is an antibiotic with an immunomodulatory action. EXEGESIS: In case of idiopathic anterior scleritis or scleritis associated with autoimmune diseases, immunosuppressive treatment is often required. We report on six patients with anterior idiopathic scleritis non sensitive to local treatment where cotrimoxazole improved or cured the symptoms. CONCLUSION: Cotrimoxazole seems to be an interesting therapeutic treatment in non threatening anterior scleritis.

Aged↗

PubMedDate not supplied

Early manifestation of vogt-koyanagi-harada disease as unilateral posterior scleritis.

PURPOSE: To describe a patient with an initial diagnosis of unilateral posterior scleritis who developed bilateral Vogt-Koyanagi-Harada (VKH) disease 12 months later. CASE: A 38-year-old woman was diagnosed with posterior scleritis in her right eye at successive examinations. The left eye showed no signs of ocular inflammation. OBSERVATIONS: Her right eye developed a second attack of posterior scleritis 3 months after the initial diagnosis. Twelve months after the first incident, granulomatous uveitis and sunset glow fundus were observed in both eyes. At the same time, lymphocytosis was found in the cerebrospinal fluid, and she was HLA DR-4-positive. In addition, poliosis was noted. CONCLUSIONS: The final diagnosis was primarily VKH disease with presenting signs and symptoms of unilateral posterior scleritis. We therefore recommend that when following a patient with posterior scleritis include VKH disease in the differential diagnosis.

Adult↗

PubMed2002

Posterior scleritis associated with Borrelia burgdorferi (Lyme disease) infection.

OBJECTIVE: To report on the clinical findings in a patient with posterior scleritis associated with infection with Borrelia burgdorferi. DESIGN: Interventional case report. PARTICIPANT: A 39-year-old male ranger who experienced posterior scleritis after several tick bites with erythema migrans. TESTING: Extensive ophthalmic and systemic workup, including serologic testing and imaging techniques. RESULTS: Sonography and contrast-enhanced computed tomography showed a large scleral mass (16 x 12 x 13 mm) in a patient with painful proptosis in the left eye with episcleral vascular dilation, reduction in bulbar motility, and chorioretinal folds in the upper temporal quadrant. Treatment with high-dose corticosteroids resulted in rapid regression of clinical symptoms and of the scleral mass. Intensive workup revealed immunoglobulin M antibodies (enzyme-linked immunoassay, Western immunoblot) and a positive lymphocyte transformation assay against B. burgdorferi. No other cause for posterior scleritis could be identified. CONCLUSIONS: Posterior scleritis should be added to the list of ocular manifestations associated with Lyme disease. Because corticosteroids alone resulted in rapid improvement of clinical symptoms, the scleritis might be mediated by autoimmunologic mechanisms.

Adult↗

PubMed2002

A prospective evaluation of subconjunctival injection of triamcinolone acetonide for resistant anterior scleritis.

PURPOSE: Prospective evaluation of the efficacy and safety of subconjunctival triamcinolone injections for resistant, nonnecrotizing, anterior scleritis. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 10 consecutive patients seen in the Doheny Eye Institute between August 1999 and December 2000 with diffuse, nonnecrotizing anterior scleritis that was resistant to systemic antiinflammatory therapy. Eyes with a history of steroid response were excluded. INTERVENTION: Subconjunctival injection of triamcinolone acetonide to the areas of maximal inflammation. MAIN OUTCOME MEASURES: Scleritis activity, adverse treatment effects, and number of systemic medications required at the end of the follow-up period. RESULTS: Within 1 to 14 days after injection, complete resolution of signs and symptoms was achieved in 11 eyes and partial resolution in 1 eye. Two patients had one recurrence each, 2.5 and 11 months after injection. Six of 10 patients were able to discontinue all systemic therapy (prednisone +/- immunosuppressive drugs); the remaining 4 needed continued oral therapy for systemic indications. Transient ocular hypertension and subconjunctival hemorrhage occurred in one eye each. Median follow-up period was 15 months. No eye developed necrotizing scleritis. CONCLUSIONS: Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment for resistant, nonnecrotizing anterior scleritis. It provides rapid effect, is well tolerated, and may spare patients the significant complications and side effects of systemic corticosteroid and immunosuppressive therapy.

Adult↗

PubMed2004

Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis.

OBJECTIVE: To assess the efficacy and safety of the anti-tumor necrosis factor alpha agent infliximab in treatment-resistant uveitis and scleritis. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Seven patients with noninfectious ocular inflammatory disease that was refractory to alternative immunosuppression. These included one patient with idiopathic retinal vasculitis and panuveitis, one patient with intermediate uveitis, one patient with chronic juvenile anterior uveitis, three patients with scleritis, and one patient with scleritis and peripheral ulcerative keratitis. Four patients had an underlying systemic disease that was in remission in three cases. INTERVENTION: Infusions of infliximab, 200 mg, were given at 4-week to 8-week intervals, depending on the clinical response. MAIN OUTCOME MEASURES: Clinical response, including symptoms, visual acuity, degree of scleral vascular engorgement, corneal thinning, anterior chamber activity, and posterior segment inflammation, reduction in concomitant immunosuppression, and adverse effects. RESULTS: The mean patient age was 47 years (range, 24-78), and four patients were female. The mean number of infliximab infusions was seven (range, 2-19), and the mean follow-up period was 12 months (range, 4-22 months). Six patients experienced a clinical improvement, with five achieving remission and significant reduction in immunosuppression. One patient showed an initial response but developed a delayed hypersensitivity response that precluded further treatment. No other adverse effects occurred. CONCLUSIONS: Infliximab seems to be an effective and safe treatment for noninfectious uveitis and scleritis and may be indicated as rescue therapy for relapses of ocular inflammation or as maintenance therapy when conventional immunosuppression has failed. Further investigation of infliximab for treatment-resistant scleritis and uveitis is warranted.

Adult↗

PubMed1988

Toxoplasmic scleritis.

Although toxoplasmosis is the most common infectious cause of posterior intraocular inflammation, it is rarely described in association with scleritis. The authors present five cases of toxoplasmosis with scleritis. Two of the five cases were diagnosed clinically and serologically as having toxoplasmosis. Their retinochoroiditis and scleritis responded well to medical therapy. Retinochroiditis and scleritis that was refractory to treatment developed in the other three patients, two of whom had been receiving immunosuppressive therapy for systemic diseases. Their therapeutic regimens did not include treatment for toxoplasmosis. All three eyes became blind and were enucleated. Results of pathologic examination of all three enucleated eyes showed Toxoplasma gondii in the retina. There was severe inflammation of the retina, choroid, and sclera. Toxoplasmosis should be considered in the clinical differential diagnosis of scleritis associated with retinochoroiditis, particularly in immunosuppressed patients.

Adult↗

PubMed1995

Scleritis after glaucoma filtering surgery with mitomycin C.

BACKGROUND: Adjunctive intraoperative mitomycin C increases the success of glaucoma filtering surgery, but also the postoperative complications. This is the first report of scleritis after its use. PATIENTS: In five patients, scleritis developed 3 to 24 weeks after inferior trabeculectomy with mitomycin C. The onset was characterized by acute pain, redness of the eye, and decreased vision. Three patients had anterior scleritis and two had posterior scleritis. Infection or bleb leakage was not seen in any patient. RESULTS: All patients responded to a course of topical steroids and oral ibuprofen or prednisone. CONCLUSION: Anterior and posterior scleritis may complicate the use of topical mitomycin C during trabeculectomy, Prompt diagnosis and treatment reverses the inflammation, maintaining the success of the surgical procedure.

Administration, Oral↗

PubMed2005

Therapeutic decision in anterior scleritis: our experience at a tertiary care eye center.

PURPOSE: To determine the characteristics of patients with anterior scleritis at a tertiary care eye center and determine which factors in these patients were associated with the need for systemic immunosuppressive therapy. PATIENTS AND METHODS: Retrospective study. Fifty patients with anterior scleritis presenting to the Cornea Service at Wills Eye Hospital from August 1996 to August 2001 were reviewed and divided into two groups. The control group included 35 patients who responded to oral non-steroid anti-inflammatory drugs (NSAIDs) and/or systemic steroids. The study group consisted of 15 patients who required additional treatment with systemic immunosuppressive agents. The influence of demographics, type of scleritis, bilateral disease, and ocular complications were analyzed. The presence of a systemic autoimmune disease, the best corrected visual acuity (BCVA), medications, and complications related to treatment were recorded. The statistical significance was evaluated by Student's t test for independence samples and Fisher's exact test; P<0.05 was considered significant. RESULTS: After a mean follow-up of 19.3 +/- 24.9 months, an associated systemic autoimmune disease was present in 17 patients (34%). Scleritis was the first manifestation of the systemic disease in 10 out of 17 patients (59%). Patients who required immunosuppressive treatment had more frequent ocular complications (80% versus 26%, P=0.0004) than did patients who responded to oral NSAIDs and/or steroids. CONCLUSIONS: Scleritis may be the sign of presentation of a systemic autoimmune disease. The presence of ocular complications, in particular corneal involvement, may be associated with the need for systemic immunosuppressive therapy.

Adolescent↗

PubMed2005

Smoking delays the response to treatment in episcleritis and scleritis.

PURPOSE: To evaluate the influence of smoking on comorbidity, treatment, visual and general outcome in patients with scleritis. METHODS: The smoking habits of 103 patients with a diagnosis of episcleritis or scleritis were evaluated. These patients were treated by one ruling protocol at the Leiden University Medical Center between 1997 and 2000. Medical records of each patient were evaluated in detail. Data on possible factors concerning smoking were collected by postal questionnaire. RESULTS: Of all 103 patients diagnosed with either episcleritis or scleritis, 41 (39.8%) were smoking during treatment of the scleral inflammation. In total, 19 patients (18.4%) had a smoking history while 43 (41.7%) patients have never smoked. The response to any of the given medications could be delayed by at least 4 weeks in many smoking patients (odds ratio (OR) 5.4 [95% confidence interval 1.9-15.5]), particularly those with posterior scleritis. Smoking patients above the age of 48 years were even more likely to respond belatedly to any given therapy (OR 6.6 [2.1-20.7]). However, having a smoking history did not delay the response. Furthermore, smoking did not worsen the visual prognosis and was not associated with additional recurrences or ocular complications after successful treatment. CONCLUSIONS: Although scleritis patients who smoked during treatment eventually responded, there was frequently over a month's delay before the medication became effective when compared to nonsmokers. This was irrespective of the type of disease or given therapy. As a consequence, smokers required more intensive therapy than those who did not smoke.

Adolescent↗

PubMed1998

Recurrent scleritis in lepromatous leprosy.

BACKGROUND: Recurrent immune-mediated scleritis after adequate treatment of leprosy is not well documented in the literature. We describe an Australian resident with unilateral intra-ocular lepromatous leprosy who had persistent non-infectious scleritis. METHODS: A man of Anglo-Indian ancestry initially presented with lepromatous leprosy and unilateral ocular involvement. The affected eye had an interstitial keratitis and a granulomatous anterior uveitis that responded to antileprotics and anti-inflammatory agents. Despite systemic cure with triple antileprotic therapy, he developed recurrent scleritis that required multiple scleral patch grafts for scleral thinning and, subsequently, an enucleation. Histology failed to demonstrate persistent infection, rather a chronic non-granulomatous scleritis, which was probably immune mediated. RESULTS/CONCLUSIONS: This case demonstrates an ocular complication of leprosy that is infrequently reported. Patients with ocular involvement by leprosy are at risk of developing recurrent scleritis despite systemic cure with antileprotics.

Anterior Chamber↗

PubMed1998

[Diode laser cyclophotocoagulation of secondary glaucoma caused by anterior, necrotizing scleritis].

PATIENT: A 60-year-old female patient presented with recurrent anterior, necrotizing scleritis with inflammation and a newly developed secondary glaucoma in the right eye. Anterior uveitis occurred some years before. Severe scleral thinning was circumferentially present and focal scleral ectasia was found. Physical examination revealed no systemic association of scleritis. Immunosuppressive therapy with metotrexate was initiated and control of scleritis achieved. Intraocular pressure elevation persisted and was refractory to glaucoma medication. Diurnal pressure curve showed IOP-values of 40 mm Hg despite the use of systemic carbonic anhydrase inhibitors. Visual acuity was 20/50 in the right and 20/25 in the left eye. METHOD: Diode laser cyclophotocoagulation (Oculight SLx 810 nm, Iris Medical Instruments Inc. California, USA) was performed under general anaesthesia using reduced parameters for application (12 laser spots, 1 second, 1.25 W). No complications occurred during and after laser application. Postoperatively, intraocular pressure was within normal range between 14 and 18 mm Hg. No reactivation of scleritis or uveitis was seen. CONCLUSION: In our experience, diode laser cyclophotocoagulation is effective and safe in treating secondary glaucoma associated with anterior, necrotizing scleritis with inflammation and uveitis using reduced parameters for application.

Female↗

PubMed2006

Atypical pneumococcal scleritis after pterygium excision: case report and literature review.

PURPOSE: To describe an unusual case of pneumococcal scleritis after pterygium excision and to review the literature on infectious scleritis associated with pterygium excision. METHODS: Case report and literature review. RESULTS: A 58-year-old white man underwent excision of a nasal pterygium of the right eye. Two weeks postoperatively, the patient developed an infectious scleritis caused by Streptococcus pneumoniae. The scleritis was complicated with hypopyon and a scleral necrosis area 6 mm away from the superior limbus with a positive Seidel test. Topical and systemic antibiotics resolved the case without any surgical procedures. CONCLUSION: Streptococcus pneumoniae must be considered as a possible agent in cases of necrotizing scleritis associated with pterygium excision.

Anti-Bacterial Agents↗

PubMed2006

Immunologic and clinical manifestations of infectious scleritis after pterygium excision.

PURPOSE: To present the immunologic status and clinical manifestations of patients who had infectious scleritis after pterygium excision. METHODS: This prospective noncomparative study of immunologic status and clinical manifestations involved 18 eyes of 18 patients with infectious scleritis (16 bacterial and 2 fungal infections) with a history of pterygium excision from 1999 to 2001. RESULTS: The period between pterygium excision and scleritis ranged from 1 to 36 years. None of the 18 patients had any history of systemic autoimmune disease. Elevated erythrocyte sedimentation rates were found in 9 (50%) of 18 patients. Elevated serum C-reactive protein levels were found in 9 (75%) of 12 patients. Other serologic tests were all negative. The most common pathogen of infectious scleritis, Pseudomonas aeruginosa, was present in 13 patients (72.2%), significantly higher than any others (P < 0.05). All of the eyeballs were salvaged, and 9 (50%) of 18 patients had final vision better than 2/20. CONCLUSION: There was no underlying autoimmune disease associated with infectious scleritis in this study. Early diagnosis and aggressive medical and surgical treatment might have saved the eyes.

Aged↗

PubMed1992

Serum interleukin (IL-1 beta) in patients with diffuse scleritis.

Scleritis is a painful, destructive inflammatory eye disease. We measured serum IL-1 beta in ten patients with diffuse scleritis and in control subjects matched for age and sex. Patients with diffuse scleritis were found to have significantly elevated serum concentrations of IL-1 beta in comparison to normal subjects (P less than 0.02). The results suggest that IL-1 beta is associated with diffuse scleritis and may influence scleral breakdown in diffuse scleritis.

Adult↗