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Scleritis in Emergency Medicine Follow-up

  • Author: Theodore J Gaeta, DO, MPH, FACEP; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Dec 29, 2015
 

Further Outpatient Care

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  • Referral to an ophthalmologist is mandatory.
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Further Inpatient Care

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  • Inpatient care rarely is indicated for scleritis, unless complicated by serious exacerbation of underlying disorder.
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Inpatient & Outpatient Medications

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  • A variety of NSAIDs is available to choose from, including diflunisal, naproxen, indomethacin, piroxicam, sulindac, and ibuprofen. These are particularly effective in nodular and diffuse scleritis and ordinarily are prescribed for at least 1 week.
  • High-dose oral prednisone is used primarily in necrotizing scleritis and severe nonnecrotizing scleritis.
  • Immunosuppressives are used as an adjunct when steroids alone fail to control progression of the disease and include cyclosporine, azathioprine, cyclophosphamide, and methotrexate. These drugs have serious side effects and contraindications and should be prescribed only by a physician who is well aware of their actions.
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Transfer

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  • If global perforation is suspected, transfer to a center with a qualified ophthalmologist may be necessary.
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Complications

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  • Scleral thinning leading to global perforation is the most devastating complication.
  • Visual impairment is a possible complication.
  • Cornea is affected more than 50% of time. Damage to the cornea may include the following: uveitis, keratitis, glaucoma, and cataracts.[24]
  • Posterior chamber derangements may include the following: optic neuritis, choroidal detachment, macular edema, retinal hemorrhage and/or detachment, and papilledema.
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Prognosis

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  • Necrotizing scleritis, the most destructive type of scleritis, and scleritis with extensive scleral thinning or perforation convey less favorable prognoses than other types of scleritis.
  • Prognosis of scleritis, when originating from systemic disorders, usually conforms to the course of the underlying disease.
  • A recent study demonstrated that spectral domain optical coherence tomography may be useful in following up on patient response to treatment.[25]
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Patient Education

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  • 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

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, Clerkship Directors in Emergency Medicine, Alliance for Clinical Education

Disclosure: Nothing to disclose.

Coauthor(s)

Diana Valcich, MD Attending Physician, Department of Emergency Medicine, North Shore LIJ Hospital System

Diana Valcich, MD is a member of the following medical societies: American College of Emergency Physicians

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.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jerome FX Naradzay, MD, Loice Swisher, MD, and Jonathan Adler, MD, to the development and writing of this article.

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