Follow-up
Further Inpatient Care
- In cases of pending scleral perforation, peripheral ulcerative keratitis perforation, or positive Seidel test, admit for scleral patch grafting.
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.
Inpatient & Outpatient Medications
- Systemic medications include NSAIDs, corticosteroids, or immunomodulatory agents, depending on the type of scleritis and/or associated disease.
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
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.
Patient Education
- For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Eye Pain.
Miscellaneous
Medicolegal Pitfalls
- Failure to inform patient and family of the adverse effects of NSAIDs, corticosteroids, or immunomodulatory agents
- Failure to treat with immunosuppressive agents in cases of scleritis associated with Wegener granulomatosis or polyarteritis nodosa
- Failure to establish or attempt to identify an underlying infectious or autoimmune etiology in severe, recurrent, or recalcitrant cases of scleritis
More on Scleritis |
| Overview: Scleritis |
| Differential Diagnoses & Workup: Scleritis |
| Treatment & Medication: Scleritis |
 Follow-up: Scleritis |
| References |
| « Previous Page |
References
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Cazabon S, Over K, Butcher J. The successful use of infliximab in resistant relapsing polychondritis and associated scleritis. Eye. Feb 2005;19(2):222-4. [Medline].
Cheung CMG, Murray PI, Savage COS. Successful treatment of Wegener´s granulomatosis associated scleritis with rituximab. Br J Ophthalmol. 2005;89:1542-1543. [Medline].
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Further Reading
Keywords
scleromalacia perforans, necrotizing scleritis, brawny scleritis, diffuse scleritis, sectorial scleritis, nodular scleritis, scleromalacia, scleral inflammation, anterior scleritis, posterior scleritis
