eMedicine Specialties > Emergency Medicine > Rheumatology
Scleritis: Differential Diagnoses & Workup
Updated: Apr 14, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Cerebral tumor
Chronic lymphocytic leukemia
Immunosuppression
Collagen vascular disease
Workup
Laboratory Studies
- Depending on the clinical suspicion, laboratory studies may be warranted. Laboratory tests include, but are not limited to, the following:
- Complete blood count (CBC) and electrolytes
- Erythrocyte sedimentation rate (ESR)
- FTA-ABS (RPR)
- Uric acid
- Rheumatoid factor
- Antinuclear antibody (ANA)
- The ED is the ideal location to initiate evaluation for collagen vascular disease, infection (conjunctival cultures), and immunocompetency. If scleritis is suspected, the emergency physician will contact an ophthalmologist. This would be a good opportunity to establish an evaluation and intervention plan. Getting the laboratory studies in the ED will save time for the patient and practitioners.
Imaging Studies
- B-scan ultrasonography may assist in detecting posterior scleritis. MRI or CT scans may play a role, but they should be ordered in consultation with an ophthalmologist.
- Chest radiography may be indicated to look for underlying pulmonary involvement arising from systemic disease.
- Imaging of sacroiliac joints is prudent when ankylosing spondylitis is suspected.
Other Tests
- Instillation of phenylephrine, a mydriatic vasoconstrictor, helps differentiate deep scleral episcleral blood vessel involvement from superficial involvement; superficial vessels blanch following application of phenylephrine, while deeper vessels remain unaffected.
- Seidel test helps detect possible global perforation. Apply a moistened fluorescein strip over the potential site of perforation while viewing under a slit lamp. If perforation exists, the fluorescein dye becomes diluted by the aqueous humor, appearing as a green dilute stream within the dark, concentrated, orange dye.
Procedures
- Apply an eye shield when scleral thinning or global perforation is suspected.
- Ensure that the eye guard does not contact the eyelid or globe.
- Apply tape from the forehead to zygoma.
- In the absence of an eye shield, use a paper or polystyrene cup, provided it is large enough to cover the eye without placing undue pressure on the globe.
More on Scleritis |
| Overview: Scleritis |
 Differential Diagnoses & Workup: Scleritis |
| Treatment & Medication: Scleritis |
| Follow-up: Scleritis |
| References |
| « Previous Page | Next Page » |
References
Ahmadi-Simab K, Lamprecht P, Nölle 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].
Ashok D, Ayliffe WH, Kiely PD. Necrotizing scleritis associated with rheumatoid arthritis: long-term remission with high-dose infliximab therapy. Rheumatology (Oxford). Jul 2005;44(7):950-1. [Medline].
Bauer AM, Fiehn C, Becker MD. Celecoxib, a selective inhibitor of cyclooxygenase 2 for therapy of diffuse anterior scleritis. Am J Ophthalmol. Jun 2005;139(6):1086-9. [Medline].
Bonfioli AA, Orefice F. Toxoplasmosis. Semin Ophthalmol. Jul-Sep 2005;20(3):129-41. [Medline].
Boonman ZF, de Keizer RJ, Watson PG. Smoking delays the response to treatment in episcleritis and scleritis. Eye. Sep 2005;19(9):949-55. [Medline].
Burton BJ, Cunningham ET Jr, Cree IA, Pavesio CE. Eye involvement mimicking scleritis in a patient with chronic lymphocytic leukaemia. Br J Ophthalmol. Jun 2005;89(6):775-6. [Medline].
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].
Deokule S, Saeed T, Murray PI. Deep intramuscular methylprednisolone treatment of recurrent scleritis. Ocul Immunol Inflamm. Feb 2005;13(1):67-71. [Medline].
Fahim K, Houghton O, Dastjerdi M, Mian SI. Posterior scleritis secondary to Pseudomonas aeruginosa keratitis. Cornea. Oct 2005;24(7):879-81. [Medline].
Fong LP, Sainz de la Maza M, Rice BA, Kupferman AE, Foster CS. Immunopathology of scleritis. Ophthalmology. Apr 1991;98(4):472-9. [Medline].
Legmann A, Foster CS. Noninfectious necrotizing scleritis. Int Ophthalmol Clin. Winter 1996;36(1):73-80. [Medline].
Leung S, Ashar BH, Miller RG. Bisphosphonate-associated scleritis: a case report and review. South Med J. Jul 2005;98(7):733-5. [Medline].
McCluskey P, Wakefield D. Intravenous pulse methylprednisolone in scleritis. Arch Ophthalmol. Jun 1987;105(6):793-7. [Medline].
McMullen M, Kovarik G, Hodge WG. Use of topical steroid therapy in the management of nonnecrotizing anterior scleritis. Can J Ophthalmol. Jun 1999;34(4):217-21. [Medline].
Okhravi N, Odufuwa B, McCluskey P, Lightman S. Scleritis. Surv Ophthalmol. Jul-Aug 2005;50(4):351-63. [Medline].
Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for scleritis. Ophthalmology. Sep 1993;100(9):1372-6. [Medline].
Sainz de la Maza M, Jabbur NS, Foster CS. Severity of scleritis and episcleritis. Ophthalmology. Feb 1994;101(2):389-96. [Medline].
Smith JR, Mackensen F, Rosenbaum JT. Therapy insight: scleritis and its relationship to systemic autoimmune disease. Nat Clin Pract Rheumatol. Apr 2007;3(4):219-26. [Medline]. [Full Text].
Thill M, Richard G. Giant pigment epithelial tear and retinal detachment in a patient with scleritis. Retina. Jul-Aug 2005;25(5):667-8. [Medline].
Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. Mar 1976;60(3):163-91. [Medline].
Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. Apr 2006;119(4):302-6. [Medline]. [Full Text].
Further Reading
Keywords
scleritis, sclera, leucitis, anterior scleritis, posterior scleritis, necrotizing anterior scleritis, scleromalacia perforans, diffuse anterior scleritis, eye redness, eye pain, sclerokeratitis
