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Latent tuberculosis-related scleritis: a case report Scleritis is a painful inflammatory process centered in the sclera that may involve the cornea and the underlying uvea. The etiology is commonly idiopathic or autoimmune but some cases are associated with systemic infection such as tuberculosis.In this report, we describe an unusual case of a female Moroccan patient who had a long history of bilateral recurrent scleritis associated with peripheral keratopathy and anterior uveitis. The patient (...) was diagnosed with latent tuberculosis and responded to antitubercular therapy administrated after exclusion of other aetiologies. This patient was finally diagnosed with latent tuberculosis- related scleritis.Although systemic tuberculosis is reported as a possible cause of scleritis and other ocular inflammatory manifestations, assessment of the diagnosis of tuberculosis-related ocular inflammation is challenging especially in latent forms. The treatment is largely presumptive. However, a favorable
Occult Fungal Scleritis To heighten awareness of occult fungal scleritis.Case report and review of the literature.A 73-year-old woman with diabetes mellitus was diagnosed for 3 months with immune-mediated scleritis and subsequently treated with corticosteroids. On referral, the patient had a scleral nodule with contiguous corneal infiltrate and hypopyon. Culture grew Fusarium species not further classified. The infection could not be controlled with antifungal therapy, and the eye was removed (...) . No exogenous or endogenous source for the infection could be identified by clinical history or examination.Fungal scleritis can develop in persons without a history of foreign body injury, minor trauma, or evidence of endogenous fungemia. A high index of suspicion for infectious scleritis must be maintained in persons with presumed immune-mediated scleritis who fail to respond to conventional therapy, particularly if they present with decreased visual acuity.
Uveitis Specialists and Rheumatologists Select Different Therapies for Idiopathic Non-necrotizing Anterior Scleritis Uveitis specialists and rheumatologists treat patients with anterior scleritis, but data from controlled trials to guide management are scarce, making differences in treatment paradigms possible.1044 uveitis specialists and rheumatologists were surveyed regarding therapy for a patient with anterior scleritis. Respondents were asked to select first- and second-choice therapies (...) < 0.015). Cost and insurance considerations were not significant.Uveitis specialists and rheumatologists have different preferences in the treatment of anterior scleritis. The difference is impacted more by specialty practice than by cost/insurance.
Refractory necrotizing scleritis successfully treated with adalimumab Necrotizing scleritis is the most severe and destructive form of scleritis with vision-threatening sequelae. It is divided into with inflammation and without inflammation (scleromalacia perforans). Adalimumab is a tumour necrosis factor (TNF)-inhibiting anti-inflammatory medication licensed for the treatment of rheumatoid and psoriatic arthritis, ankylosing spondylitis and inflammatory bowel disease (in the USA). We report (...) two cases of necrotizing scleritis successfully treated with adalimumab.
Efficacy and safety of immunosuppressive agents in the treatment of necrotising scleritis: a retrospective, multicentre study in Korea. To investigate the efficacy and safety of cyclophosphamide and other immunosuppressive agents (ISAs) in the treatment of necrotising scleritis.We reviewed the medical records of patients with necrotising scleritis at 11 tertiary care centres in South Korea from 2002 to 2012, treated with ISAs within 3 months of follow-up period. We divided patients into two (...) ).The efficacy of cyclophosphamide in the treatment of necrotising scleritis was comparable with that of other ISAs. However, the rate of discontinuation due to side effects was much higher in the CYC group.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Scleritis in patients with granulomatosis with polyangiitis (Wegener). To describe and compare clinical features, complications and outcomes in patients with granulomatosis with polyangiitis (GPA)-associated scleritis with those seen in idiopathic and other autoimmune-associated scleritis, and to further describe the features that may serve as an indicator of life-threatening systemic disease.We retrospectively reviewed electronic health records of all patients with scleritis seen at two (...) tertiary care centres. Of 500 patients, 14 had GPA-associated scleritis and were included in this analysis. Measures included were age, gender, laterality, visual acuity and underlying systemic or ocular diseases. Clinical features (location, pain, inflammation) and ocular complications of these patients (decrease of vision, concomitant anterior uveitis and ocular hypertension) were studied and correlated.Fourteen of 500 patients with scleritis were GPA associated. Most of the patients with GPA
NODULAR POSTERIOR SCLERITIS: Clinico-Sonographic Characteristics and Proposed Diagnostic Criteria. To report the clinical and ultrasound features and outcomes of a series of nodular posterior scleritis.Retrospective medical record review of 11 consecutive patients with nodular posterior scleritis. Patient demographics, ocular and systemic findings, ultrasound features, and final anatomical and visual outcomes were recorded.There were 9 females and 2 males (11 eyes) with mean age at presentation (...) %) of mean elevation of 4.1 mm. There was nodular thickening of the sclera (100%) and fluid in Tenon space or "T" sign (36%). A complete regression of the nodule after the treatment was observed only in 1 patient (11%) and partial regression in 4 patients (44%).Nodular posterior scleritis should be considered in the differential diagnosis of a single amelanotic choroidal mass showing high internal reflectivity on ultrasound B-scan. It can produce intraocular inflammation in 50% of the cases and may
Optical Coherence Tomography in the Diagnosis of Scleritis and Episcleritis. To describe the optical coherence tomography (OCT) findings in eyes with active anterior scleritis and compare the findings to those with episcleritis and normal controls.Prospective evaluation of a diagnostic test.We included a total of 30 eyes of 30 patients with unilateral anterior scleral or episcleral inflammation. The contralateral 30 eyes with no active ocular disease served as controls. OCT was performed over (...) the anterior sclera in the inflamed area on all cases. The OCT images were analyzed to determine the thickness of the sclera and the presence or absence of scleral hyporeflective areas representing intrascleral edema.There were 17 male and 13 female patients. The mean age was 43 years with an age range of 21-77 years. Eighteen patients had anterior scleritis and 12 patients had episcleritis. The mean transconjunctival scleral thickness was 747 μm (SD ± 68.97) with a range of 616-877 μm in normal eyes, 882
Necrotizing Scleritis, Conjunctivitis, and Other Pathologic Findings in the Eye and Brain of an Ebola Virus-Infected Rhesus Macaque (Macaca mulatta) with Apparent Recovery and a Delayed Time of Death. A 3.5-year-old adult female rhesus macaque (Macaca mulatta) manifested swelling of the left upper eyelid and conjunctiva and a decline in clinical condition 18 days following intramuscular challenge with Ebola virus (EBOV; Kikwit-1995), after apparent clinical recovery. Histologic lesions (...) with strong EBOV antigen staining were noted in the left eye (scleritis, conjunctivitis, and peri-optic neuritis), brain (choriomeningoencephalitis), stomach, proximal duodenum, and pancreas. Spleen, liver, and adrenal glands, common targets for acute infection, appeared histologically normal with no evidence of EBOV immunoreactivity. These findings may provide important insight for understanding sequelae seen in West African survivors of Ebola virus disease. Published by Oxford University Press
Risk Factors and Clinical Outcomes of Bacterial and Fungal Scleritis at a Tertiary Eye Care Hospital The aim was to analyze demographics, risk factors, pathogenic organisms, and clinical outcome in cases with microbiologically proven bacterial or fungal scleritis.Retrospective review of all the medical records of patients with microbiologically proven infectious scleritis examined from March 2005 to December 2009 in the cornea services of L. V. Prasad Eye Institute, Hyderabad, India (...) was noted in 9 eyes (22%) and diabetes mellitus in 7 patients (17%). Associated keratitis was noted in 9 eyes (21.4%). The scleral abscess was unifocal in 33 eyes (78.5%), multifocal in 6 eyes (14.2%) and diffuse in 3 eyes (7.14%). The final follow-up ranged from 24 days to 37 months. The final visual acuity was better in 18 eyes (42.8%), stable in 13 (30.9%), and deteriorated in 7 eyes (16.6%). Recurrence was seen in 4 eyes (9.5%).Surgery is a major risk factor for infectious scleritis in our series
Posterior Scleritis with Inflammatory Retinal Detachment A 14-year-old African American male presented to the emergency department with worsening left eye redness, swelling, and vision loss over the preceding three days. History was notable for similar eye redness and swelling without vision loss four months earlier, which improved following a brief course of prednisone. He endorsed mild eye irritation and tearing with bright lights. There was no history of fever, respiratory symptoms or trauma
Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia To describe the clinical features, systemic associations, treatment and visual outcomes in Saudi patients with scleritis.A retrospective chart review was performed for patients with scleritis presenting to two tertiary care eye hospitals in Riyadh, Saudi Arabia, from 2001 to 2011. Data were collected on the clinical features of scleritis, subtypes of scleritis, associated systemic (...) disease, history of previous ocular surgery and medical therapy, including the use of immunosuppressants. Treatment outcomes were evaluated based on best-corrected visual acuity (BCVA) and response to treatment.Of the 52 patients included in the study, non-necrotizing anterior scleritis was the most common type of scleritis in 22 patients (42.3%), followed by posterior scleritis in 14 patients (26.9%). The majority of cases, 31 patients (59.6%), were idiopathic in nature. Systemic associations were
A case of giant nodular posterior scleritis mimicking choroidal malignancy To report a case of giant nodular posterior scleritis mimicking a choroidal tumor. A 42-year-old lady with systemic hypertension presented with a 1-week history of unilateral visual loss, pain and redness in her left eye. Examination showed sectoral anterior episcleritis in her left eye as well as a dome-shaped choroidal mass at the inferior-temporal periphery, associated with retinal hemorrhages and subretinal fluid (...) . Systemic evaluation and imaging of the choroidal mass were performed and could not rule out amelanotic choroidal melanoma. At the same time, she was prescribed a 2-week course of oral nonsteroidal anti-inflammatory drug (NSAID) for her sectoral anterior episcleritis. The choroidal mass was found to have resolved completely right before her scheduled fine needle biopsy. Diagnosis of nodular posterior scleritis and a trial of oral NSAID can be considered in patients presenting with a choroidal mass
Scleritis and Kidney Disease - More than meets the eye... Renal Fellow Network: Scleritis and Kidney Disease - More than meets the eye... | | | | | Wednesday, March 11, 2015 Scleritis and Kidney Disease - More than meets the eye... Scleritis is a severe inflammation involving the deep episclera and sclera. Symptoms include moderate to marked pain, hyperemia of the globe, lacrimation, and photophobia. Scleritis tends to recur and is frequently associated with an underlying systemic illness (...) , such as rheumatoid arthritis, lupus, IgA vasculitis, polyarteritis nodosa and granulomatosis with polyangiitis. A few cases are infectious in origin and about half of the cases of scleritis have no known cause. In Renal Grand Rounds on Tuesday, Patrick McGlynn presented a case of 30 year-old healthy female who came to clinic complaining of pain and redness on her right eye. Blood pressure was elevated at 155/90 mmHg. On exam, right eye had redness on sclera. No involvement of left eye. No papilledema
A case of nodular posterior scleritis mimicking choroidal mass The aim of this study is to report clinical and imaging findings, and treatment outcomes of a patient with nodular posterior scleritis. A 41-year-old woman was diagnosed as nodular posterior scleritis in the light of clinical and imaging findings. At first admission best corrected visual acuity was 20/50 in her right eye. Fundus examination revealed an amelanotic subretinal mass under the superior temporal arcade associated (...) with subretinal fluid surrounding it. B-scan ultrasonography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography findings confirmed the diagnosis. As treatment, nepafenac eye drops 3 times a day, and flurbiprofen tablet 100 mg twice a day were prescribed. After 4 weeks of treatment, the ocular pain was relieved, BCVA improved to 20/20, and subretinal mass totally regressed. Although the diagnosis of nodular posterior scleritis may be confusing, it has to be kept in mind
Rituximab Therapy for Refractory Scleritis: Results of a Phase I/II Dose-Ranging, Randomized, ClinicalÂ Trial. To determine whether rituximab, a monoclonal antibody against the B-lymphocyte antigen CD20, is effective in the treatment of refractory noninfectious scleritis.Prospective, dose-ranging, randomized, double-masked phase I/II clinical trial.Twelve patients with noninfectious scleritis refractory to systemic corticosteroid and ≥1 other systemic immunosuppressive agent were enrolled from (...) January 2007 to March 2010.Subjects were randomly assigned to 500 (n = 5) or 1000 mg (n = 7) dosing arms of rituximab intravenous infusions (500 or 1000 mg), given at study days 1 and 15. Initial responders with breakthrough inflammation after study week 24 were offered treatment with an additional cycle of 2 open-label rituximab 1000 mg infusions.Primary outcomes were reduction of inflammation, as measured with a validated scleritis disease grading scale (SGS) and reduction in corticosteroid dose
Spectroscopic measurements in scleritis: Bluish-red or deep red? To design a slit-lamp mountable spectrometer for the assessment of ophthalmic patients and to illustrate a potential clinical application by measuring the spectral characteristics of inflamed eyes of differing aetiologies.A slit lamp mountable instrument was designed and built, and methods for data analysis developed. Reflectance spectra were recorded from two patients with scleritis, three with non-scleritic red eyes and from two (...) of the eye were made using an innovative, slit-lamp mountable spectrometer and its functionality demonstrated by differentiating the spectra from eyes with differing pathologies. While intending only to illustrate one potential application; for the cases examined, our results indicate that inflamed scleritic eyes exhibit a longer wavelength red light with no increase in shorter wavelength blue light. Thus our measurements would seem to confirm that the perceived redness of scleritis differs from other
Scleritis (Follow-up) Scleritis Treatment & Management: Medical Care, Surgical Care, Consultations Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIyODMyNC10cmVhdG1lbnQ= processing > Scleritis Treatment (...) & Management Updated: Nov 01, 2018 Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Andrew A Dahl, MD, FACS Share Email Print Feedback Close Sections Sections Scleritis Treatment Medical Care Treatment of scleritis almost always requires systemic therapy. Patients with an associated disease, such as rosacea, gout, atopy, or infection, need disease-specific treatment. Systemic therapy complements aggressive topical corticosteroid therapy, generally with difluprednate, prednisolone or loteprednol
Scleritis (Diagnosis) Scleritis: Practice Essentials, Background, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIyODMyNC1vdmVydmlldw== processing > Scleritis Updated: Nov 01, 2018 Author (...) : Manolette R Roque, MD, MBA, FPAO; Chief Editor: Andrew A Dahl, MD, FACS Share Email Print Feedback Close Sections Sections Scleritis Overview Practice Essentials Scleral inflammation (scleritis) may occur in one or both eyes. Pain is a hallmark symptom. Signs of scleritis include focal or diffuse redness or violaceous discoloration, initial scleral thickening, late scleral thinning, nodules, and scleral necrosis. It may be associated with keratitis, iritis, glaucoma, and exudative retinal detachment
Scleritis (Diagnosis) Scleritis in Emergency Medicine: Practice Essentials, Pathophysiology, Etiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODA5MTY2LW92ZXJ2aWV3 processing > Scleritis in Emergency (...) Medicine Updated: Dec 31, 2018 Author: Theodore J Gaeta, DO, MPH, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP Share Email Print Feedback Close Sections Sections Scleritis in Emergency Medicine Overview Practice Essentials Scleritis is an inflammatory disease that affects the sclera; it may be localized, nodular, or diffuse. [ ] It may involve the anterior (visible segment) and/or posterior segments of the eye and manifest with redness of the eye and severe eye pain [ , ] Patients with isolated