Scleritis Follow-up

  • Author: Maite Sainz de la Maza, MD, PhD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 18, 2010
 

Further Inpatient Care

  • In cases of pending scleral perforation, peripheral ulcerative keratitis perforation, or positive Seidel test, admit for scleral patch grafting.
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Further Outpatient Care

  • Patients should have a scleral examination and general eye examination at every follow-up visit.
  • Carefully monitor medication type, dose, and adverse effects. In case of therapeutic failure, change the medication type.
  • Consultation with other specialists for associated systemic disease and/or immunosuppressive therapy follow-up care is recommended.
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Inpatient & Outpatient Medications

  • Systemic medications include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or immunomodulatory agents, depending on the type of scleritis and/or associated disease.
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Complications

  • Keratopathy - Peripheral corneal thinning, acute stromal keratitis, sclerosing keratitis, or peripheral ulcerative keratitis
  • Uveitis - Anterior or posterior
  • Glaucoma
  • Cataract
  • Fundus abnormalities - Choroidal folds, subretinal mass, disk edema, macular edema, annular ciliochoroidal detachment, or serous retinal detachment
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Prognosis

  • Ocular prognosis of scleritis with systemic autoimmune diseases varies, depending on the specific autoimmune disease.
    • Scleritis in spondyloarthropathies or in systemic lupus erythematosus, usually a relatively benign and self-limiting condition, is diffuse scleritis or nodular scleritis without ocular complications.
    • Scleritis in Wegener granulomatosis is a severe disease that can lead to permanent blindness; it is usually necrotizing scleritis with ocular complications.
    • Scleritis in rheumatoid arthritis or relapsing polychondritis is a disease of intermediate severity; it may be diffuse, nodular, or necrotizing scleritis with or without ocular complications.
    • Scleritis without systemic disease association is often more benign than scleritis accompanied by infection or autoimmune disease. These cases of idiopathic scleritis may be mild, shorter in duration, and more likely to respond to topical steroid drops alone.
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Patient Education

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Contributor Information and Disclosures
Author

Maite Sainz de la Maza, MD, PhD  Associate Professor, Division of Ocular Immunology and Uveitis, Department of Ophthalmology, Hospital Clinico y Provincial, Barcelona, Spain

Maite Sainz de la Maza, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology and American Uveitis Society

Disclosure: Nothing to disclose.

Specialty Editor Board

John D Sheppard Jr, MD, MMSc  Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Program Director, Ophthalmology Residency Training, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  4. [Guideline] Zimmerman RD, Seidenwurm DJ, Davis PC, et al. ACR Appropriateness Criteria. Orbits, vision, and visual loss. National Guideline Clearinghouse. 2006.

  5. Nieuwenhuizen J, Watson PG, Emmanouilidis-van der Spek K, Keunen JE, Jager MJ. The value of combining anterior segment fluorescein angiography with indocyanine green angiography in scleral inflammation. Ophthalmology. Aug 2003;110(8):1653-66. [Medline].

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  8. Sobrin L, Christen W, Foster CS. Mycophenolate mofetil after methotrexate failure or intolerance in the treatment of scleritis and uveitis. Ophthalmology. Aug 2008;115(8):1416-21, 1421.e1. [Medline].

  9. Wakefield D, McCluskey P. Cyclosporin therapy for severe scleritis. Br J Ophthalmol. Sep 1989;73(9):743-6. [Medline].

  10. Cazabon S, Over K, Butcher J. The successful use of infliximab in resistant relapsing polychondritis and associated scleritis. Eye (Lond). Feb 2005;19(2):222-4. [Medline].

  11. Huynh N, Cervantes-Castaneda RA, Bhat P, Gallagher MJ, Foster CS. Biologic response modifier therapy for psoriatic ocular inflammatory disease. Ocul Immunol Inflamm. May-Jun 2008;16(3):89-93. [Medline].

  12. Murphy CC, Ayliffe WH, Booth A, Makanjuola D, Andrews PA, Jayne D. Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis. Ophthalmology. Feb 2004;111(2):352-6. [Medline].

  13. Sobrin L, Kim EC, Christen W, Papadaki T, Letko E, Foster CS. Infliximab therapy for the treatment of refractory ocular inflammatory disease. Arch Ophthalmol. Jul 2007;125(7):895-900. [Medline].

  14. Ahmadi-Simab K, Lamprecht P, Nolle B, Ai M, Gross WL. Successful treatment of refractory anterior scleritis in primary Sjogren's syndrome with rituximab. Ann Rheum Dis. Jul 2005;64(7):1087-8. [Medline].

  15. Cheung CM, Murray PI, Savage CO. Successful treatment of Wegener's granulomatosis associated scleritis with rituximab. Br J Ophthalmol. Nov 2005;89(11):1542. [Medline].

  16. Papaliodis GN, Chu D, Foster CS. Treatment of ocular inflammatory disorders with daclizumab. Ophthalmology. Apr 2003;110(4):786-9. [Medline].

  17. Onal S, Kazokoglu H, Koc A, Yavuz S. Rituximab for remission induction in a patient with relapsing necrotizing scleritis associated with limited Wegener´s granulomatosis. Ocul Immunol Inflamm. Sep-Oct 2008;16(5):230-232.

  18. Sainz de la Maza M, Tauber J, Foster CS. Scleral grafting for necrotizing scleritis. Ophthalmology. Mar 1989;96(3):306-10. [Medline].

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  23. Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. Mar 1976;60(3):163-91. [Medline].

 
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