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Scleritis

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1. Scleritis

Scleritis Scleritis submit The College submit You're here: Scleritis Scleritis The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care. Share options Please login to view the images or . Aetiology Scleritis is a potentially severe inflammatory disease of the sclera which is bilateral in 50% of cases Predisposing factors Patients are usually in the middle age group (...) (40-60 years) M:F = 2:3 May be idiopathic, but approximately a third of cases are associated with systemic inflammatory disease, of which the scleritis may be the first presentation: rheumatoid arthritis granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) systemic lupus erythematosus polyarteritis nodosa inflammatory bowel disease syphilis sarcoidosis, TB Local causes: e.g. herpes zoster, trauma, surgery (surgery-induced necrotizing scleritis, SINS) Symptoms Moderate

2018 College of Optometrists

2. Nocardial scleritis: A case report and a suggested algorithm for disease management based on a literature review (PubMed)

Nocardial scleritis: A case report and a suggested algorithm for disease management based on a literature review To report a case of nocardial scleritis and to propose a logical treatment algorithm based on a literature review.It is important to suspect a nocardial infection when evaluating anterior unilateral scleritis accompanied by multiple purulent or necrotic abscesses, especially in male patients with a history of chronic ocular pain and redness, trauma inflicted by organic materials (...) data on a total of 43 eyes with nocardial scleritis. Our proposed algorithm may afford a useful understanding of this sight-threatening disease, facilitating easier and faster diagnosis and management.

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2018 American journal of ophthalmology case reports

3. Combination nivolumab- and cabiralizumab-associated acute bilateral anterior and posterior scleritis and anterior uveitis (PubMed)

Combination nivolumab- and cabiralizumab-associated acute bilateral anterior and posterior scleritis and anterior uveitis To report on a case of uveitis and scleritis resulting as an immune-mediated side effect of cancer immunotherapy with nivolumab and cabiralizumab.Bilateral anterior nongranulomatous anterior uveitis and bilateral diffuse anterior and posterior scleritis occurred following the use of combination cancer immunotherapy. The uveitis and scleritis resolved following temporary

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2018 American journal of ophthalmology case reports

4. Tectonic corneal lamellar grafting for surgically-induced necrotizing scleritis after strabismus surgery: Case report & literature review (PubMed)

Tectonic corneal lamellar grafting for surgically-induced necrotizing scleritis after strabismus surgery: Case report & literature review To report the first case of infectious surgically-induced necrotizing scleritis following strabismus surgery which was treated successfully with a tectonic corneal graft.We report a case of surgically-induced necrotizing scleritis after strabismus surgery in a 61-year-old gentleman with gout and a subconjunctival abscess. Surgical drainage (...) with aggressive local and systemic treatment, tectonic lamellar keratoplasty provides good therapeutic and tectonic results for scleral necrosis after strabismus surgery. This case also demonstrates the importance of screening for associated systemic risk factors in any patient with scleritis for appropriate, targeted therapy.

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2018 American journal of ophthalmology case reports

5. Histopathological evaluation of scleritis. (PubMed)

Histopathological evaluation of scleritis. The sclera is an uncommon site of primary inflammation. Biopsy is infrequently employed in the evaluation of scleritis, but familiarity with its differential diagnosis is instrumental in ensuring efficient histological evaluation. This review provides a clinical overview of scleritis and describes the context in which scleral biopsy might arise. Most cases are associated with systemic autoimmune disease, but a sizeable proportion occur as an isolated (...) disorder. Conditions mimicking autoimmune scleritis include infection and neoplasm. Histological patterns of inflammation in eyes removed surgically or at autopsy have been placed into three groups: (1) autoimmune scleritis characterised by varying mixtures of palisading granulomas, necrosis and vasculitis; (2) infectious scleritis, characterised by acute inflammation and necrosis; and (3) idiopathic scleritis, characterised by chronic non-specific inflammation with follicles and varying amounts

2019 Journal of Clinical Pathology

6. Remission Of Non-Infectious Anterior Scleritis: Incidence And Predictive Factors. (PubMed)

Remission Of Non-Infectious Anterior Scleritis: Incidence And Predictive Factors. To assess how often non-infectious anterior scleritis remits and identify predictive factors.Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three (...) consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models.During 1,391 years' aggregate follow-up of 825 affected eyes, remission occurred in 399 (299 of 588 patients). Median time-to-remission of scleritis=3.1 years (95% confidence interval (CI): 2.6, 3.9). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis

2019 American Journal of Ophthalmology

7. Scleritis and anterior uveitis may herald the development of an epibulbar tumor in patients with extranodal Rosai-Dorfman disease: a case report. (PubMed)

Scleritis and anterior uveitis may herald the development of an epibulbar tumor in patients with extranodal Rosai-Dorfman disease: a case report. Rosai-Dorfman disease is a rare non-Langerhans cell histiocytosis. Ocular involvement is even rarer, mostly involving the orbit and eyelids, although marginal corneal ulcers, uveitis, and epibulbar masses have also been reported, and is characterized by multiple recurrences. However, the disease course and optimal treatment strategies remain (...) undetermined, in light of the rarity of this disease.We reported a 36-year-old male patient with the extranodal form of Rosai-Dorfman disease, presenting with scleritis and anterior uveitis in the left eye, who experienced subsequent development of an epibulbar tumor in the same eye. The patient was also complicated by a relapsing facial nodule on the right cheek. After the pathological diagnosis of Rosai-Dorfman disease was obtained, the patient underwent surgical excision of the epibulbar tumor

2019 BMC Ophthalmology

8. A case report of infectious scleritis with corneal ulcer caused by Scedosporium aurantiacum. (PubMed)

A case report of infectious scleritis with corneal ulcer caused by Scedosporium aurantiacum. Scedosporium species is rare pathogen of ocular infection. The accurate diagnosis is delaying in many cases and the clinical prognosis is poor due to its resistance to antifungal agents. This report describes a patient with infectious scleritis and corneal ulcer caused by Scedosporium auranticum infection who required enucleation to control the infection.A 70-year-old woman visited our clinic after (...) . Evisceration was performed due to corneal perforation, and enucleation was also performed for dehiscence of the conjunctiva and scleral necrosis.After enucleation, postoperative systemic voriconazole treatment controlled the infection without recurrence.S aurantiacum keratitis is difficult to eradicate, even with several months of treatment with systemic and topical antifungal agents, and tends to progress to scleritis. The infection can be terminated by the orbital enucleation. Infection with this rare

2019 Medicine

9. An unusual case of Behcet disease with posterior scleritis: A case report. (PubMed)

An unusual case of Behcet disease with posterior scleritis: A case report. Posterior scleritis is an ocular inflammatory disorder that can be associated with both infectious and non-infectious immune reactions. Behcet disease is a chronic, relapsing, multisystemic inflammatory disorder with uveitis. There are no reported cases of posterior scleritis with Bechet disease.A 50-year-old man previously diagnosed with systemic Behcet disease presented with ocular pain and decreased vision in the left (...) eye.Posterior scleritis associated with Behcet disease was diagnosed based on optical coherence tomography showing choroidal folds, as well as contrast computed tomography and ultrasound sonography demonstrating thickening of the posterior sclera.Treatment with systemic corticosteroids was initiated. Since inflammation relapsed during steroid tapering, anti-tumor necrosis factor-alpha (TNF-α) therapy was used in combination, and tapering of steroids was possible without recurrence of inflammation for 12

2019 Medicine

10. Anterior infectious necrotizing scleritis secondary to Pseudomonas aeruginosa infection following intravitreal ranibizumab injection (PubMed)

Anterior infectious necrotizing scleritis secondary to Pseudomonas aeruginosa infection following intravitreal ranibizumab injection To report the occurrence and management of severe infectious scleritis in a 75 year-old woman following intravitreal ranibizumab injection.A 75 year-old monocular woman receiving monthly intravitreal ranibizumab injection for wet age related macular degeneration in the left eye presented with severe dull pain, decreased vision, and scleral melt with discharge 2 (...) after two weeks of intravenous, oral and, topical antibiotics.To our knowledge, this is the first case of anterior infectious necrotizing scleritis secondary to Pseudomonas aeruginosa infection following intravitreal ranibizumab injection. Clinicians performing intravitreal injections should have a high index of suspicion for iatrogenic infections including scleritis and endophthalmitis, as these infections require aggressive topical and systemic antibiotics as well as possible hospitalization.

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2016 American journal of ophthalmology case reports

11. Chemotherapy-induced anterior necrotising scleritis: A case report (PubMed)

Chemotherapy-induced anterior necrotising scleritis: A case report We describe a case of anterior necrotising scleritis secondary to Gemcitabine and Carboplatin chemotherapy agents in a patient with metastatic breast cancer, which has not been previously reported.A 50-year-old lady with recurrent metastatic breast cancer presented with unilateral subconjunctival haemorrhage secondary to severe thrombocytopenia eight days following palliative chemotherapy in the form of Gemcitabine (...) and Carboplatin. Twelve days following the initial presentation, the subconjunctival haemorrhage had resolved, however there was evidence of anterior necrotising scleritis with anterior chamber reaction and hypotony with choroidal effusion. This resolved with three days of intravenous Methylprednisolone along with topical steroids and the area of necrosis remained stable.Due to the chronological order of events, we infer a Gemcitabine and Carboplatin-induced anterior necrotising scleritis, which has not been

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2016 American journal of ophthalmology case reports

12. Unilateral surgically induced Necrotizing Scleritis after trabeculectomy with Ologen in a patient with pigmentary glaucoma (PubMed)

Unilateral surgically induced Necrotizing Scleritis after trabeculectomy with Ologen in a patient with pigmentary glaucoma In this report we record the first surgically induced Necrotizing Scleritis case related to trabeculectomy with the use of Ologen Collagen Matrix Implant.Surgically induced Necrotizing Scleritis is a rare pathological entity that complicates ocular (sclera) surgery.Prompt management of surgically induced Necrotizing Scleritis related to trabeculectomy with the use of Ologen

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2016 American journal of ophthalmology case reports

13. Clinical profile of patients with posterior scleritis: A report from Eastern India (PubMed)

Clinical profile of patients with posterior scleritis: A report from Eastern India This study aimed to report the clinical profile of patients with posterior scleritis at a tertiary eye center in Eastern India.This was a single-center retrospective case series of patients who were diagnosed as posterior scleritis between January 2010 and December 2014, with a follow-up period of at least 6 months.The study included 18 patients of posterior scleritis with a mean age of 41.2 ± 10.6 years (range (...) : 26-63 years). With female preponderance (55.6%), majority of the posterior scleritis cases were unilateral (88.9%). Sixteen patients reported with diminution of vision, eleven patients (61.1%) had ocular pain on presentation, and five patients complained of headache. Concurrent anterior scleritis was found in three eyes (15%) with posterior scleritis. Choroidal folds and subretinal fluid at the posterior pole were the most common fundus findings and were seen in seven eyes (35%) each. No systemic

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2018 Indian journal of ophthalmology

14. Isolation of acid from eye drop bottles being used by patients presenting with presumed scleritis (PubMed)

Isolation of acid from eye drop bottles being used by patients presenting with presumed scleritis The aim of the study was to report the occurrence of contamination/replacement of ophthalmic eye drops with liquids of acidic nature in patients treated for nonresponding scleritis.This was a retrospective interventional case series study.Of the three patients (4 eyes) referred as necrotizing scleritis, two were found to have acid as the content in the bottle/s being used as eye drops, confirmed (...) using biochemical tests. All four eyes had tarsal ischemia and tarsal conjunctival defect in addition to severe scleral ischemia involving the inferior bulbar area. All four eyes required tenonplasty with amniotic membrane transplant more than once for the ocular surface to heal. Two of the three patients were on systemic immunosuppressives including pulse cyclophosphamide for refractory necrotizing scleritis. Sulfuric and hydrochloric acid was isolated from the bottles of 2nd and 3rd patient using

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2018 Indian journal of ophthalmology

15. Commentary: Posterior scleritis: Nuances to discern and handle effectively! (PubMed)

Commentary: Posterior scleritis: Nuances to discern and handle effectively! 30038153 2018 07 25 2018 12 02 1998-3689 66 8 2018 08 Indian journal of ophthalmology Indian J Ophthalmol Commentary: Posterior scleritis: Nuances to discern and handle effectively! 1113-1114 10.4103/ijo.IJO_639_18 Murugan S Bala SB Uveitis Services, Aravind Eye Hospital, Puducherry, India. eng Journal Article Comment India Indian J Ophthalmol 0405376 0301-4738 0 Immunosuppressive Agents IM Indian J Ophthalmol. 2018 Aug (...) ;66(8):1109-1112 30038152 Fluorescein Angiography Humans Immunosuppressive Agents Scleritis There are no conflicts of interest 2018 7 25 6 0 2018 7 25 6 0 2018 7 26 6 0 ppublish 30038153 IndianJOphthalmol_2018_66_8_1113_237346 10.4103/ijo.IJO_639_18 PMC6080434 Surv Ophthalmol. 1988 Mar-Apr;32(5):297-316 3043740 Indian J Ophthalmol. 1998 Dec;46(4):195-202 10218301 Ophthalmology. 2003 Jan;110(1):15-21; quiz 22-3 12511340 AJNR Am J Neuroradiol. 2016 Dec;37(12):2334-2339 27444937 Indian J Ophthalmol

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2018 Indian journal of ophthalmology

16. Iontophoretic delivery of dexamethasone phosphate for non-infectious, non-necrotising anterior scleritis, dose-finding clinical trial. (PubMed)

Iontophoretic delivery of dexamethasone phosphate for non-infectious, non-necrotising anterior scleritis, dose-finding clinical trial. Currently available treatment options for non-infectious scleritis, including non-steroidal anti-inflammatory drugs, systemic corticosteroids and immunosuppressive therapies, have both efficacy and side effect limitations. Iontophoretic delivery of corticosteroids has been demonstrated to be effective for anterior uveitis and represents a potential new approach (...) to scleritis therapy. We hypothesised that iontophoretic delivery would provide effective and precise medication delivery to the sclera, while limiting systemic exposure and side effects. This first-in-human randomised, double-masked, dose-escalating study of iontophoretic administration of dexamethasone phosphate for scleritis suggests the treatment to be well tolerated and safe (within the limitations of the 18 patients sample size). There was a suggestion of efficacy in the lowest (1.2 mA/min at 0.4 mA

2018 British Journal of Ophthalmology

17. A case of scleritis associated rheumatoid arthritis accompanying an intraocular elevated lesion. (PubMed)

A case of scleritis associated rheumatoid arthritis accompanying an intraocular elevated lesion. Scleritis and/or uveitis sometimes accompanies patients who suffer from rheumatoid arthritis. However, few studies have reported scleritis and/or uveitis accompanying a fundus elevated lesion, such as an intraocular tumor. In this study, we report a case of rheumatoid uveitis associated with an intraocular elevated lesion.A 66-year-old female visited another eye clinic and was diagnosed as bilateral

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2018 BMC Ophthalmology

18. Scedosporium apiospermum infectious scleritis following posterior subtenon triamcinolone acetonide injection: a case report and literature review. (PubMed)

Scedosporium apiospermum infectious scleritis following posterior subtenon triamcinolone acetonide injection: a case report and literature review. Ubiquitous fungi of the Scedosporium apiospermum species complex (SASC) cause various opportunistic infections. Posterior subtenon triamcinolone acetonide (STTA) injection is a standard therapy for intraocular inflammation and macular edema. We report a case of Scedosporium apiospermum infectious scleritis after a posterior STTA injection.A 75-year (...) debridement and topical VRCZ were resumed, with the eye finally improving after 5 months of management. The fungal species was identified as Scedosporium apiospermum sensu stricto morphologically and by DNA sequencing.This case was successfully treated by topical and systemic VRCZ and repeated surgical debridement. Infectious scleritis caused by SASC rarely develops after posterior STTA. SASC can produce conidia in the enclosed subtenon space. Late-onset infectious scleritis after a posterior STTA

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2018 BMC Ophthalmology

19. Infectious Scleritis: What the ID Clinician Should Know (PubMed)

Infectious Scleritis: What the ID Clinician Should Know Scleritis is an inflammatory process involving the outer coating of the globe which is characterized by focal or diffuse hyperemia, moderate to severe pain, and frequent impairment of vision. Most cases of scleritis are autoimmune in nature and are managed with topical and/or systemic corticosteroids. Infectious scleritis is a less common entity, occurring in 5%-10% of cases, and requiring directed antimicrobial therapy. We present a case (...) of Nocardia farcinica anterior nodular scleritis diagnosed via positive culture of an excisional biopsy of a scleral nodule. The patient improved after combined surgical and medical therapy with amoxicillin-clavulanate and moxifloxacin for 12 months. Based on a literature review, a summary of reported cases of infectious scleritis is provided, and guidelines pertaining to diagnosis and management are offered.

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2018 Open forum infectious diseases

20. Atypical posterior scleritis mimicking choroidal melanoma (PubMed)

Atypical posterior scleritis mimicking choroidal melanoma We report a case of atypical posterior scleritis mimicking amelanotic choroidal melanoma. A 30-year-old healthy Filipino man, with a history of painless subacute loss of vision in his left eye over 5 months, was referred to our institute for further workup and management. On examination, visual acuity of the left eye was 20/200. Anterior segment examination yielded unremarkable results, with injected conjunctiva and quiet episcleral (...) blood vessels, while fundus examination revealed non-pigmented nasal choroidal mass, with significant subretinal fluid resembling amelanotic choroidal melanoma. Right eye examination yielded unremarkable results. The patient was diagnosed with atypical posterior scleritis, and treated with oral steroids for 2 weeks, with no improvement. A periocular steroid was then injected to the left eye, causing dramatic reduction in choroidal mass size, and complete resolution of subretinal fluid. The visual

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2018 Saudi medical journal

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