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Scleritis Follow-up

  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
 
Updated: Apr 11, 2016
 

Further Outpatient Care

Patients should undergo a room-light scleral examination, a slit-lamp evaluation, 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 a rheumatologist for associated systemic disease and/or immunomodulatory therapy follow-up care is recommended.

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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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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

See the list below:

  • Keratopathy - Peripheral corneal thinning, acute stromal keratitis, sclerosing keratitis, interstitial keratitis, punctate keratopathy, 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 granulomatosis with polyangiitis 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

For excellent patient education resources, visit eMedicineHealth's Eye and Vision Center. Also, see eMedicineHealth's patient education article Eye Pain.

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Contributor Information and Disclosures
Author

Manolette R Roque, MD, MBA, FPAO Section Chief, Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief, Ocular Immunology and Uveitis, International Eye Institute, St Luke's Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic; Director, AMC Eye Center, Alabang Medical Center

Manolette R Roque, MD, MBA, FPAO is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Philippine Medical Association, American Uveitis Society, International Ocular Inflammation Society, Philippine Ocular Inflammation Society, American Society of Ophthalmic Administrators, American Academy of Ophthalmic Executives, Philippine Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, 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, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, 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, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

References
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