scleritis

Summary

Summary: Refers to any inflammation of the sclera including episcleritis, a benign condition affecting only the episclera, which is generally short-lived and easily treated. Classic scleritis, on the other hand, affects deeper tissue and is characterized by higher rates of visual acuity loss and even mortality, particularly in necrotizing form. Its characteristic symptom is severe and general head pain. Scleritis has also been associated with systemic collagen disease. Etiology is unknown but is thought to involve a local immune response. Treatment is difficult and includes administration of anti-inflammatory and immunosuppressive agents such as corticosteroids. Inflammation of the sclera may also be secondary to inflammation of adjacent tissues, such as the conjunctiva.

Top Publications

  1. Moloney G, Branley M, Kotsiou G, Rhodes D. Syphilis presenting as scleritis in an HIV-positive man undergoing immune reconstitution. Clin Exp Ophthalmol. 2004;32:526-8 pubmed
    ..Examination demonstrated focal anterior scleritis with underlying retinitis and a mild vitritis...
  2. Vagefi M, Hollander D, Seitzman G, Margolis T. Bilateral surgically induced necrotising scleritis with secondary superinfection. Br J Ophthalmol. 2005;89:124-5 pubmed
  3. Moore M, Beith J. Acute unilateral anterior uveitis and scleritis following a single infusion of zoledronate for metastatic breast cancer. Med J Aust. 2008;188:370-1 pubmed
  4. Smith J, Cunningham E. Atypical presentations of ocular toxoplasmosis. Curr Opin Ophthalmol. 2002;13:387-92 pubmed
    ..pigmentary retinopathy mimicking retinitis pigmentosa, neuroretinitis and other forms of optic neuropathy, and scleritis. Although in the past most cases of ocular toxoplasmosis were considered to result from reactivation of a ..
  5. Chen Y, Chung P, Hsiao C. Stenotrophomonas maltophilia keratitis and scleritis. Chang Gung Med J. 2005;28:142-50 pubmed
    ..The report describes six cases of Stenotrophomonas maltophilia (S. maltophilia) keratitis and scleritis. To our knowledge, this is the foremost report of S. maltophilia scleritis.
  6. Kim J, Perkins S, Harris G. Voriconazole treatment of fungal scleritis and epibulbar abscess resulting from scleral buckle infection. Arch Ophthalmol. 2003;121:735-7 pubmed
  7. Seo K, Lee H, Kim E, Lee J. Expression of tumor necrosis factor alpha and matrix metalloproteinase-9 in surgically induced necrotizing scleritis. Ophthalmic Res. 2006;38:66-70 pubmed
    Surgically induced necrotizing scleritis is primarily managed with immunosuppressive regimens...
  8. Mazokopakis E, Kalikaki A, Stathopoulos E, Vrentzos G, Papadakis J. Acute febrile neutrophilic dermatosis (Sweet's syndrome) with erythema nodosum and anterior scleritis. A case report. Int J Dermatol. 2005;44:1051-3 pubmed
  9. Starosta M, Brandwein S. Clinical manifestations and treatment of rheumatoid pachymeningitis. Neurology. 2007;68:1079-80 pubmed

More Information

Publications62

  1. Dursun D, Akova Y, Yucel E. Myositis and scleritis associated with Behcet's disease: an atypical presentation. Ocul Immunol Inflamm. 2004;12:329-32 pubmed
    ..In addition to an anterior necrotizing scleritis, she had several attacks of retrobulbar neuritis and lateral rectus myositis. She responded well to i.v...
  2. Leung S, Ashar B, Miller R. Bisphosphonate-associated scleritis: a case report and review. South Med J. 2005;98:733-5 pubmed
    ..Six weeks after alendronate therapy began, scleritis developed in the patient's right eye...
  3. Das S, Saunders M, Cheng A, Whiting M. Nodular non-necrotising anterior scleritis due to Nocardia nova infection. Eye (Lond). 2007;21:276-8 pubmed
  4. Sainz De La Maza M, Foster C, Jabbur N, Baltatzis S. Ocular characteristics and disease associations in scleritis-associated peripheral keratopathy. Arch Ophthalmol. 2002;120:15-9 pubmed
    To evaluate ocular characteristics and systemic disease associations in patients with scleritis-associated peripheral keratopathy and its different patterns, and to assess any ocular or systemic prognostic significance of the presence of ..
  5. Theodossiadis P, Markomichelakis N, Sfikakis P. Tumor necrosis factor antagonists: preliminary evidence for an emerging approach in the treatment of ocular inflammation. Retina. 2007;27:399-413 pubmed
    ..Infliximab was also beneficial in small numbers of patients with idiopathic uveitis or scleritis, birdshot retinochoroiditis, uveitic and diabetic cystoid macular edema, and age-related macular degeneration...
  6. Fincher T, Fulcher S. Diagnostic and therapeutic challenge of Aspergillus flavus scleritis. Cornea. 2007;26:618-20 pubmed
    To discuss the diagnostic and therapeutic challenges involved in the management of Aspergillus flavus scleritis and present a review of related literature.
  7. Ebrahimi K, Green W, Grebe R, Jun A. Acanthamoeba sclerokeratitis. Graefes Arch Clin Exp Ophthalmol. 2009;247:283-6 pubmed publisher
    Acanthamoeba scleritis is an uncommon but severe complication of acanthamoeba keratitis. We report the clinical and histopathologic features of a patient with acanthamoeba sclerokeratitis.
  8. Johnson K, Chu D. Evaluation of sub-Tenon triamcinolone acetonide injections in the treatment of scleritis. Am J Ophthalmol. 2010;149:77-81 pubmed publisher
    To suggest that sub-Tenon triamcinolone acetonide (TA) injections may be a helpful supplement in patients with scleritis.
  9. Lin H, Ma D, Chen Y, Yeh L, Hsiao C. Late-onset intrascleral dissemination of Stenotrophomonas maltophilia scleritis after pterygium excision. Cornea. 2011;30:712-5 pubmed publisher
    To report a case of pterygium excision-related infectious scleritis with late-onset intrascleral dissemination.
  10. Hwang Y, Chen Y, Lai C, Chen H, Hsiao C. Infectious scleritis after use of immunomodulators. Arch Ophthalmol. 2002;120:1093-4 pubmed
  11. Erkanli L, Akova Y, Guney Tefekli E, Tugal Tutkun I. Clinical features, prognosis, and treatment results of patients with scleritis from 2 tertiary eye care centers in Turkey. Cornea. 2010;29:26-33 pubmed publisher
    To evaluate the spectrum of scleritis from 2 tertiary eye care centers in Turkey.
  12. Metta H, Corti M, Brunzini R. Disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess. Braz J Infect Dis. 2008;12:260-2 pubmed
    ..We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit ..
  13. Zamir E, Read R, Smith R, Wang R, Rao N. A prospective evaluation of subconjunctival injection of triamcinolone acetonide for resistant anterior scleritis. Ophthalmology. 2002;109:798-805; discussion 805-7 pubmed
    Prospective evaluation of the efficacy and safety of subconjunctival triamcinolone injections for resistant, nonnecrotizing, anterior scleritis.
  14. Maruo H, Shiraishi A, Hara Y, Maruo Y, Ohashi Y. Necrotizing nocardial scleritis successfully treated with surgical debridement and topical polyvinyl alcohol iodine and antibiotics. J Ocul Pharmacol Ther. 2011;27:415-8 pubmed publisher
    To report a case of necrotizing nocardial scleritis treated with surgical debridement and topical polyvinyl alcohol iodine (PAI) and antibiotics.
  15. Hodson K, Galor A, Karp C, Davis J, Albini T, Perez V, et al. Epidemiology and visual outcomes in patients with infectious scleritis. Cornea. 2013;32:466-72 pubmed publisher
    To describe the epidemiology of patients with infectious scleritis and identify factors associated with poor visual prognosis.
  16. Ramos Esteban J, Jeng B. Posttraumatic Stenotrophomonas maltophilia infectious scleritis. Cornea. 2008;27:232-5 pubmed publisher
    To describe the history, clinical presentation, and successful surgical and antibiotic management of a case of posttraumatic infectious scleritis secondary to Stenotrophomonas maltophilia.
  17. Sobrin L, Kim E, Christen W, Papadaki T, Letko E, Foster C. Infliximab therapy for the treatment of refractory ocular inflammatory disease. Arch Ophthalmol. 2007;125:895-900 pubmed
    ..To report the outcomes of infliximab therapy in the treatment of ocular inflammatory disease refractory to traditional immunomodulatory therapy (IMT)...
  18. Restrepo J, Molina M. Successful treatment of severe nodular scleritis with adalimumab. Clin Rheumatol. 2010;29:559-61 pubmed publisher
    Ocular features may occur in longstanding rheumatoid arthritis. Among them, scleritis represents the most frequent manifestation of ophthalmologic rheumatoid disease...
  19. Srivastava S, Taylor P, Wood L, Lee S, Robinson M. Post-surgical scleritis associated with the ganciclovir implant. Ophthalmic Surg Lasers Imaging. 2004;35:254-5 pubmed
    ..A 22-year-old woman with human immunodeficiency virus infection presented with a painful left eye with scleritis overlying previous ganciclovir implant sclerotomy sites...
  20. Perez V, Azar D, Foster C. Sterile corneal melting and necrotizing scleritis after cataract surgery in patients with rheumatoid arthritis and collagen vascular disease. Semin Ophthalmol. 2002;17:124-30 pubmed
    The onset of post-operative corneal melting and necrotizing scleritis in patients with rheumatoid arthritis and collagen vascular disease who undergo cataract surgery can have devastating ocular and systemic consequences...
  21. Botsios C, Sfriso P, Ostuni P, Todesco S, Punzi L. Efficacy of the IL-1 receptor antagonist, anakinra, for the treatment of diffuse anterior scleritis in rheumatoid arthritis. Report of two cases. Rheumatology (Oxford). 2007;46:1042-3 pubmed
  22. Pavesio C, Meier F. Systemic disorders associated with episcleritis and scleritis. Curr Opin Ophthalmol. 2001;12:471-8 pubmed
    ..The diseases more commonly associated with these conditions, especially with scleritis, are the connective tissue disorders and systemic vasculitis, but systemic infections and malignancies also must ..
  23. Benderson D, Karakunnel J, Kathuria S, Badros A. Scleritis complicating zoledronic acid infusion. Clin Lymphoma Myeloma. 2006;7:145-7 pubmed
    We present a case of severe unilateral posterior scleritis associated with zoledronic acid administration that was recognized and treated in a timely manner...
  24. Sainz De La Maza M, Molina N, Gonzalez Gonzalez L, Doctor P, Tauber J, Foster C. Scleritis therapy. Ophthalmology. 2012;119:51-8 pubmed publisher
    To delineate factors associated with a successful response to treatment in patients with various manifestations of scleritis.
  25. Machado D, Curi A, Fernandes R, Bessa T, Campos W, Orefice F. [Scleritis: clinical characteristics, systemic associations, treatment and outcome in 100 patients]. Arq Bras Oftalmol. 2009;72:231-5 pubmed
    To document the clinical features, systemic association, treatment and evolution of 100 patients with scleritis evaluated at the Uveitis Service of the Federal University of Minas Gerais.
  26. Amadi Obi A, Yu C, Liu X, Mahdi R, Clarke G, Nussenblatt R, et al. TH17 cells contribute to uveitis and scleritis and are expanded by IL-2 and inhibited by IL-27/STAT1. Nat Med. 2007;13:711-8 pubmed
    ..Here we report their involvement in human uveitis and scleritis, and validate our findings in experimental autoimmune uveoretinitis (EAU), a model of uveitis...
  27. Thakker M, Perez V, Moulin A, Cremers S, Foster C. Multifocal nodular episcleritis and scleritis with undiagnosed Hodgkin's lymphoma. Ophthalmology. 2003;110:1057-60 pubmed
    To report the case of a patient with undiagnosed Hodgkin's lymphoma who presented with coexistent unilateral nodular episcleritis and scleritis.
  28. Su C, Tsai J, Chang Y, Lin C. Immunologic and clinical manifestations of infectious scleritis after pterygium excision. Cornea. 2006;25:663-6 pubmed
    To present the immunologic status and clinical manifestations of patients who had infectious scleritis after pterygium excision.
  29. Morisawa M, Yamagami S, Inoki T, Ochiai M, Tsuru T. Bilateral centripetal lipid keratopathy with diffuse anterior scleritis. Acta Ophthalmol Scand. 2003;81:202-3 pubmed
  30. Meallet M. Subpalpebral lavage antibiotic treatment for severe infectious scleritis and keratitis. Cornea. 2006;25:159-63 pubmed
    To report the subpalpebral lavage therapy for the treatment of infectious scleritis and keratitis.
  31. Stokes J, Wright M, Ramaesh K, Smith C, Dhillon B. Necrotizing scleritis after intraocular surgery associated with the use of polyester nonabsorbable sutures. J Cataract Refract Surg. 2003;29:1827-30 pubmed
    We present 2 elderly patients who developed necrotizing scleritis after cataract extraction in which the wound was sutured with polyester...
  32. Doctor P, Sultan A, Syed S, Christen W, Bhat P, Foster C. Infliximab for the treatment of refractory scleritis. Br J Ophthalmol. 2010;94:579-83 pubmed publisher
    BACKGROUND Scleritis is a potentially blinding inflammatory disorder. Standard care consists of systemic corticosteroids and immunosuppresants...
  33. Ahmadi Simab K, Lamprecht P, Nolle B, Ai M, Gross W. Successful treatment of refractory anterior scleritis in primary Sjogren's syndrome with rituximab. Ann Rheum Dis. 2005;64:1087-8 pubmed
  34. Hernandez Illas M, Tozman E, Fulcher S, Jundt J, Davis J, Pflugfelder S. Recombinant human tumor necrosis factor receptor Fc fusion protein (Etanercept): experience as a therapy for sight-threatening scleritis and sterile corneal ulceration. Eye Contact Lens. 2004;30:2-5 pubmed
    To review the efficacy of Etanercept as an alternate therapy for treatment of necrotizing anterior scleritis and sterile corneal ulceration unresponsive to traditional therapies.
  35. Sawant S, Biswas J. Fungal scleritis with exudative retinal detachment. Ocul Immunol Inflamm. 2010;18:457-8 pubmed publisher
    To report a case of fungal scleritis associated with exudative retinal detachment.
  36. Kouda N, Sasaki H, Harada S, Yamada Y, Takahashi N, Sasaki K. Early manifestation of vogt-koyanagi-harada disease as unilateral posterior scleritis. Jpn J Ophthalmol. 2002;46:590-3 pubmed
    To describe a patient with an initial diagnosis of unilateral posterior scleritis who developed bilateral Vogt-Koyanagi-Harada (VKH) disease 12 months later.
  37. Lee G, Gray T, Dart J, Pavesio C, Ficker L, Larkin D, et al. Acanthamoeba sclerokeratitis: treatment with systemic immunosuppression. Ophthalmology. 2002;109:1178-82 pubmed
    ..This study describes the clinical features, management, and outcome of 19 patients who had severe Acanthamoeba sclerokeratitis (ASK) unresponsive to conventional management, requiring systemic immunosuppression to control disease...
  38. Karalezli A, Kucukerdonmez C, Borazan M, Akova Y. Successful treatment of necrotizing scleritis after conjunctival autografting for pterygium with amniotic membrane transplantation. Orbit. 2010;29:88-90 pubmed publisher
    To report a case of necrotizing scleritis after pterygium surgery with conjunctival autografting (CA) and intraoperative Mitomycin C (MMC) and its treatment with amniotic membrane transplantation (AMT) and systemic steroid.
  39. Hoang L, Lim L, Vaillant B, Choi D, Rosenbaum J. Antineutrophil cytoplasmic antibody-associated active scleritis. Arch Ophthalmol. 2008;126:651-5 pubmed publisher
    To determine whether antineutrophil cytoplasmic antibody (ANCA) testing provides prognostic information in evaluating scleritis.
  40. Lee J, Oum B, Choi H, Lee J. Methicillin-resistant Staphylococcus aureus sclerokeratitis after pterygium excision. Cornea. 2007;26:744-6 pubmed
    ..To report a case of methicillin-resistant Staphylococcus aureus (MRSA) sclerokeratitis after pterygium excision...
  41. Cheung C, Murray P, Savage C. Successful treatment of Wegener's granulomatosis associated scleritis with rituximab. Br J Ophthalmol. 2005;89:1542 pubmed
  42. Kaplan Messas A, Barkana Y, Avni I, Neumann R. Methotrexate as a first-line corticosteroid-sparing therapy in a cohort of uveitis and scleritis. Ocul Immunol Inflamm. 2003;11:131-9 pubmed
    ..To evaluate the clinical experience with methotrexate as a first-line corticosteroid-sparing drug in patients with resistant ocular inflammation...
  43. Murphy C, Ayliffe W, Booth A, Makanjuola D, Andrews P, Jayne D. Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis. Ophthalmology. 2004;111:352-6 pubmed
    To assess the efficacy and safety of the anti-tumor necrosis factor alpha agent infliximab in treatment-resistant uveitis and scleritis.
  44. Kedhar S, Belair M, Jun A, Sulkowski M, Thorne J. Scleritis and peripheral ulcerative keratitis with hepatitis C virus-related cryoglobulinemia. Arch Ophthalmol. 2007;125:852-3 pubmed
  45. Fraunfelder F, Fraunfelder F, Jensvold B. Scleritis and other ocular side effects associated with pamidronate disodium. Am J Ophthalmol. 2003;135:219-22 pubmed
    To evaluate reported cases of scleritis and other ocular side effects associated with pamidronate disodium, with emphasis on previously unreported cases of scleritis.
  46. Shukla D, Kim R. Giant nodular posterior scleritis simulating choroidal melanoma. Indian J Ophthalmol. 2006;54:120-2 pubmed
    ..Ultrasonography was suggestive of posterior scleritis. Systemic evaluation was unremarkable. The patient was treated with high-dose systemic corticosteroids...
  47. Albini T, Rao N, Smith R. The diagnosis and management of anterior scleritis. Int Ophthalmol Clin. 2005;45:191-204 pubmed
  48. Young A, Wong S, Leung A, Leung G, Cheng L, Lam D. Successful treatment of surgically induced necrotizing scleritis with tacrolimus. Clin Exp Ophthalmol. 2005;33:98-9 pubmed
    A 46-year-old man developed surgically induced necrotizing scleritis (SINS) 7 months following uneventful primary bare sclera pterygium excision...
  49. Sonika -, Narang S, Kochhar S, Srivastava M, Gupta R, Sood S. Posterior scleritis mimicking macular serpiginous choroiditis. Indian J Ophthalmol. 2003;51:351-3 pubmed
    An unusual case of posterior scleritis mimicking macular serpiginous choroiditis is reported.
  50. Decroos F, Garg P, Reddy A, Sharma A, Krishnaiah S, Mungale M, et al. Optimizing diagnosis and management of nocardia keratitis, scleritis, and endophthalmitis: 11-year microbial and clinical overview. Ophthalmology. 2011;118:1193-200 pubmed publisher
    To identify clinical factors and microbiological assays that facilitate a rapid diagnosis of Nocardia keratitis, scleritis, and endophthalmitis, and to determine optimal medical and surgical management strategies.
  51. Mitamura Y, Fujiwara O, Miyanishi K, Sato H, Saga K, Ohtsuka K. Nodular scleritis and panuveitis with erythema elevatum diutinum. Am J Ophthalmol. 2004;137:368-70 pubmed
    To report a case of nodular scleritis and panuveitis associated with erythema elevatum diutinum, a rare immunocomplex-mediated skin disease.
  52. Sainz De La Maza M, Molina N, Gonzalez Gonzalez L, Doctor P, Tauber J, Foster C. Clinical characteristics of a large cohort of patients with scleritis and episcleritis. Ophthalmology. 2012;119:43-50 pubmed publisher
    ..the demographic characteristics, clinical features, ocular complications, and disease associations of patients with scleritis and episcleritis; as well as to delineate the risk factors for decreased vision in patients with scleritis.
  53. Shukla D, Mohan K, Rao N, Kim R, Namperumalsamy P, Cunningham E. Posterior scleritis causing combined central retinal artery and vein occlusion. Retina. 2004;24:467-9 pubmed