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PubMed2006

[A case of posterior scleritis associated with extensive retinochoroidal atrophy].

BACKGROUND: Posterior scleritis is known to exhibit various changes in the ocular fundus, but retinochoroidal atrophy is a rare complication. CASE: A 54-year-old man presented with the complaint of blurred vision in the right eye. The patient had visited our clinic twice before, 22 and 11 years earlier. Although his funduscopic findings had demonstrated choroidal detachment in both eyes, the cause could not be determined at that time. FINDINGS: His visual acuity was 20/200, OD and 20/100, OS. Funduscopic examination showed annual choroidal detachments and geographic retinochoroidal atrophy in the posterior pole OU, and serous retinal detachment OD. B-scan ultrasonograpy revealed diffuse thickening and flattening of the posterior coats of the eye, and orbital enhanced computed tomography revealed thickening and enhancement of the posterior sclera. A diagnosis of posterior scleritis was made. Prednisolone 80 mg/ day was initiated and gradually tapered. Nine months later choroidal and serous retinal detachment were resolved. CONCLUSION: We encountered a rare case of posterior scleritis with associated extensive retinochoroidal atrophy. We speculated that the cause was inflammation of the retina and choroid, and accumulation of subretinal fluid for a long period.

Atrophy↗
PubMed1993

Necrotizing scleritis and transient myopia following strabismus surgery.

Necrotizing scleritis may occur following ocular surgery, most commonly after cataract extraction. This complication developed in a 60-year-old woman following strabismus surgery for a gaze palsy and sixth-nerve paresis following a stroke. Although an autoimmune process is present in many patients with necrotizing scleritis, none was detected in this patient. Inflammation was controlled with topical and systemic corticosteroids and ibuprofen. Good visual acuity was preserved, and improved ocular alignment was achieved. Transient myopia, not previously reported in necrotizing scleritis, was observed.

Female↗
PubMed1996

[Necrotizing scleritis--case report of a patient effectively treated with high doses of corticosteroids].

A case of a patient with necrotizing scleritis of both eyes who had been under medical observation and who had undergone medical treatment for five years is described. During the first manifestation of his disease in spite of medical treatment the right eyeball ruptured and was removed. After four years scleritis in the left eye started. An intensive pulsating steroid therapy was used due to which the remission of this disease was obtained. This method of treatment of necrotizing scleritis with unknown etiology seems to be the most efficient.

Anti-Inflammatory Agents↗
PubMed1997

[Detection of mycobacterial DNA with polymerase chain reaction in eye discharge and gastric juices in a case of scleritis].

We report a case of mycobacterial scleritis in which prompt diagnosis was made by the detection of mycobacterial DNA with polymerase chain reaction (PCR) in eye discharge and gastric juices, when conventional tests were negative. A 77-year-old woman who had a past history of pulmonary tuberculosis visited the outpatient clinic of Tokai University Hospital complaining of pain in her right eye. She was diagnosed as having scleritis and uveitis. There were no indications of active tuberculosis. We examined the gastric juices, sputum, and eye discharge by microscopy, culture, and PCR for detection of mycobacterium. The results of microscopy and culture were negative, but with PCR we detected atypical mycobacterium in eye discharge and gastric juices. After oral treatment with antituberculosis agents, the patient's eye symptoms disappeared. Detecting mycobacterial DNA with PCR could be useful for early diagnosis of mycobacterial scleritis, so that treatment with antituberculosis agents could be started.

Aged↗
PubMed1976

Exudative retinal detachment and scleritis in polyarteritis.

A 64-year-old white man, treated with systemic corticosteroids for five years, developed polyarteritis. He then developed a severe scleritis with an exudative retinal detachment in the right eye, which became blind and painful and was enucleated 23 months after onset of the scleritis. Histopathologic examination of the enucleated eye revealed granulomatous scleritis, chronic nongranulomatous uveitis, exudative retinal detachment, and perivasculitis of intrascleral, iris, ciliary body, and retinal blood vessels. Systemic findings were minimal and limited to elevated sedimentation rate, weight loss, mild anemia, and microscopic hematuria. Respiratory disease, severe kidney disease, hypertension, and arthritis were notably absent. A muscle biopsy established the diagnosis.

Adrenal Cortex Hormones↗
PubMed1980

Retinal pigment epithelial detachments in posterior scleritis.

A 12-year-old girl developed posterior scleritis and many detachments of the retinal pigment epithelium. Computed axial tomographic findings, reported in posterior scleritis for the first time, disclosed thickening of the posterior sclera. Computed axial tomography appears to be a sensitive test for the diagnosis of posterior scleritis.

Child↗
PubMed1981

Rheumatoid scleritis.

A 59-year-old black female with rheumatoid arthritis developed diffuse anterior scleritis with orbital and adnexal involvement. Computerized axial tomograhy (CAT) demonstrated the location and extent of the lesion. Biopsy of subconjunctival tissue revealed a rheumatoid nodule, characterized by granulomatous inflammation and fibrinoid necrosis. The patient improved rapidly on large doses of systemic corticosteroids. The relationship of scleritis to rheumatoid arthritis is discussed. The histopathologic features of rheumatoid scleritis, its apppearance on the CAT scan, and the management of this disease are also presented.

Arthritis, Rheumatoid↗
PubMed1988

Posterior scleritis: a clinical and histological survey.

The clinical course of 47 patients with posterior scleritis is reviewed. Though clinical presentation varied widely, 73% of the patients presented with a visual acuity of 6/18 or less. Because the posterior scleritis was not always associated with pain or with anterior scleritis, the diagnosis was often not considered when the patient was first seen. The most common findings in the fundus were disc swelling, retinal detachment, and macular oedema and the most useful investigation was B scan ultrasound. No common aetiology was found, although 60% had a systemic disorder which was accompanied by a vasculitis. Those who were diagnosed and treated with the minimum delay had the most satisfactory visual outcome. However, there appears to be a group of patients with no underlying systemic disease who fail to respond to intensive therapy, and lose vision. A new sub-group of West Indians with the disease is described. The histopathology of 7 cases confirmed the presence of scleral vasculitis of the vessels in and around the sclera in all the specimens. Other significant findings include inflammatory swelling and focal loss of pigment epithelium together with choroidal vascular closure. This could account for the fluorescein angiographic findings.

Adolescent↗
PubMed1976

Evaluation of eyes enucleated for scleritis.

A series of 30 enucleated eyes, all of which had a primary histological diagnosis of scleritis, was analysed. The average age of patients at enucleation was 68 years; many of these patients had had the disease for more than 30 years. In 40 per cent the diagnosis of scleritis was unsuspected and was often masked by multiple complications. Scleritis with uveitis and glaucoma was the most common combination to come to enucleation. In 82 per cent, pain was the reason for enucleation, which suggests that some patients were on inadequate levels of steroid treatment or were unable to tolerate them. In the series, 37 per cent of the eyes perforated. Perforation occurred in those patients who were having steriods but not in those who were not, but the data are inconclusive as to which method of steroid administration was most likely to cause ocular perforation.

Adult↗
PubMed1978

Scleritis and associated disease.

One hundred patients (66 women and 34 men) who presented consecutively to Moorfields Eye Hospital with scleral disease underwent medical examination. Thirteen were found to have seropositive rheumatoid arthritis and another 16 also had rheumatoid factor present (Rheumaton test). Autoantibodies were present in 35% of patients, being most common in the elderly and most frequent in cases of necrotising and diffuse scleritis. Although scleral disease is uncommon, it is associated with connective-tissue disorders. Scleritis may be severe and destructive locally, and one series showed that 27% of patients who develop necrotising scleritis are dead from systemic complications within five years. It is therefore important for it to be correctly diagnosed and effectively treated at an early stage.

Adolescent↗
PubMed2000

Long-term follow-up of giant nodular posterior scleritis simulating choroidal melanoma.

A 41-year-old asymptomatic woman was referred for enucleation of a 7. 5-mm-thick intraocular tumor suspected to be choroidal melanoma. The clinical findings combined with imaging studies suggested instead a diagnosis of giant nodular posterior scleritis. A scleral biopsy was performed to confirm the diagnosis. After 12 years of observation, the lesion has remained stable and visual acuity has been preserved. Nodular posterior scleritis can present with no symptoms of pain, redness, or visual disturbance and can remain quiet for many years. It must be clinically differentiated from choroidal melanoma. Arch Ophthalmol. 2000;118:1290-1292

Adult↗
PubMedDate not supplied

Calcification at the posterior pole in scleritis. A case report.

We report a case with unilateral recurrent anterior scleritis which developed sclerochoroidal calcification at the posterior pole without any overt sign of posterior scleritis during the follow-up period of nine years. We believe that subtle posterior scleral inflammation might lead to sclerochoroidal calcification which might be dystrophic in nature.

Adult↗
PubMed2002

Scleritis as the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation.

PURPOSE: To describe a case of scleritis with choroidal detachment as the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation. DESIGN: Interventional case report. METHODS: Review of clinical records. RESULTS: A 50-year-old man developed symptoms of mild dry eye syndrome 20 days after receiving a one-antigen-mismatched allogenic bone marrow transplant. Five days later, he developed orbital pain, moderate visual loss, and a sterile orbital abscess on the left side. The orbital inflammatory collection was drained, and symptoms improved. On day 41 after bone marrow transplantation, the patient developed severe ocular pain and scleral thickening with secondary choroidal detachment and glaucoma in the right eye. The patient had no systemic signs of graft-versus-host disease at this time. The ocular symptoms and signs responded remarkably well to intravenous corticosteroids. Six months after bone marrow transplantation, while receiving low-dose oral methylprednisolone, the patient developed a skin rash. A biopsy of the involved skin confirmed the diagnosis of graft-versus-host disease. CONCLUSION: Scleritis can be the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation.

Acetazolamide↗
PubMed2002

Severe scleritis and urticarial lesions.

PURPOSE: To report the first known case of bilateral scleritis in a patient with hypocomplementemic urticarial vasculitis. DESIGN: Interventional case report. METHODS: Medical and ophthalmic history, results of physical and ophthalmic examinations, laboratory data, and histologic and immunopathologic examination were reviewed and results recorded. RESULTS: A 67-year-old man who presented with eye redness and pain, rash, arthralgia, and malaise was found to have hypocomplementemic urticarial vasculitis. Treatment with high-dose oral corticosteroids and mycophenolate mofetil resulted in the resolution of the rash and scleritis. CONCLUSIONS: Ocular involvement may be a helpful clue in the diagnosis of this uncommon syndrome.

Aged↗
PubMed1992

Posterior scleritis in children.

Posterior scleritis was diagnosed in four adolescent boys. These patients represented a distinct subgroup of patients with posterior scleritis that differed from the adult variant by gender, lack of systemic disease, and absence of the associated ocular findings often seen in the adult variant of the disorder. The four patients had diminished visual acuity, ocular pain, and exudative retinal detachments at initial examination. Fluorescein angiography demonstrated multiple pinpoint leaks at the level of the retinal pigment epithelium in three patients with late-phase patchy staining of a mass-like lesion in one patient. B-scan ultrasonography demonstrated choroidal and scleral thickening with increased acoustic density of the choroid in all patients. Systemic evaluation of these patients disclosed no underlying disease. Clinical signs and symptoms resolved in three of the patients after treatment with low-dose, orally administered corticosteroid or noncorticosteroid anti-inflammatory medication. High systemic doses of corticosteroid in combination with noncorticosteroid anti-inflammatory medication and local corticosteroid therapy was required to induce remission in one patient. All patients recovered good visual acuity.

Adolescent↗
PubMed1995

Scleritis, uveitis, and glaucoma in a patient with rheumatic fever.

PURPOSE: To determine the origin of scleritis, uveitis, and glaucoma in a boy with fever, sore throat, joint pains, and malaise. METHODS: The patient underwent extensive hematologic, serologic, rheumatologic, and radiologic examinations. RESULTS: The patient recovered after extensive medical therapy. He met the Jones criteria for the diagnosis of acute rheumatic fever and had an increased result for antistreptolysin O antibody titer. CONCLUSIONS: Antistreptococcal antibody testing is helpful in diagnosing rheumatic fever as a cause of scleritis, uveitis, and glaucoma.

Acute Disease↗
PubMed1990

Acute scleritis in porphyria cutanea tarda.

We examined three patients who had dermatologic and biochemical manifestations of porphyria cutanea tarda and localized thinning or excavation in the sun-exposed interpalpebral sclera, adjacent to the cornea. All three patients had signs of acute scleritis. The acute scleritis responded to oral indomethacin in one patient, but systemic corticosteroids were required to control the inflammation in the other two patients. Phlebotomy, protection from sunlight, and refraining from alcohol played an important part in the treatment of the patients.

Acute Disease↗
PubMed1994

Treatment strategies for scleritis and uveitis associated with inflammatory bowel disease.

We treated 19 patients with anterior uveitis, episcleritis, or scleritis associated with inflammatory bowel disease. Adequate control of ocular inflammation was achieved in 16 patients (84%). Ocular inflammation was adequately controlled with corticosteroids alone, without systemic adverse effects, in only three patients, all of whom had anterior uveitis associated with ulcerative colitis. Systemic nonsteroidal anti-inflammatory drugs proved beneficial in six of seven patients, and one additional patient benefited from another anti-inflammatory drug (hydroxychloroquine sulfate). Systemic cytotoxic immunosuppressive therapy was used in the remaining seven patients, six of whom had bilateral disease. Ocular inflammation was controlled in six of these patients. Azathioprine was beneficial for scleritis but was less effective for anterior uveitis, especially in Crohn's disease, thus necessitating the use of another cytotoxic agent. HLA-B27-positive anterior uveitis was more refractory to corticosteroid therapy and was more likely to require systemic cytotoxic immunosuppressive therapy. With the medical and surgical strategies described, vision was improved or maintained in all patients in the study group.

Administration, Topical↗