eMedicine Specialties > Emergency Medicine > Rheumatology

Scleritis: Follow-up

Author: Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; 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
Coauthor(s): Diana Valcich, MD, Staff Physician, Department of Emergency Medicine, New York Methodist Hospital
Contributor Information and Disclosures

Updated: Apr 14, 2008

Follow-up

Further Inpatient Care

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

Further Outpatient Care

  • Referral to an ophthalmologist is mandatory.

Inpatient & Outpatient Medications

  • 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
    • These agents 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.

Transfer

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

Complications

  • 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.
  • Posterior chamber derangements may include the following: optic neuritis, choroidal detachment, macular edema, retinal hemorrhage and/or detachment, and papilledema.

Prognosis

  • 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.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to differentiate scleritis from the more benign, self-limited episcleritis. A quick bedside test to help distinguish the two entities involves instillation of 1-2 drops of 2.5% phenylephrine into the involved eye; episcleral vessels blanch upon application, while deeper scleral vessels remain unaffected.
  • Failure to see discoloration representing scleral thinning because discoloration is overlooked easily in a darkened room
  • Failure to document visual acuity before proceeding to any manipulation of the eye or instillation of medications
  • Failure to shield the eye if global perforation or scleral thinning is present
 
Acknowledgments

The authors and editors of eMedicine 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.



More on Scleritis

Overview: Scleritis
Differential Diagnoses & Workup: Scleritis
Treatment & Medication: Scleritis
Follow-up: Scleritis
References
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References

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Further Reading

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Keywords

scleritis, sclera, leucitis, anterior scleritis, posterior scleritis, necrotizing anterior scleritis, scleromalacia perforans, diffuse anterior scleritis, eye redness, eye pain, sclerokeratitis

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Contributor Information and Disclosures

Author

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; 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, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Diana Valcich, MD, Staff Physician, Department of Emergency Medicine, New York Methodist Hospital
Diana Valcich, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone, III, MD, Associate Professor, Department of Emergency Medicine, Truman Medical Center, University of Missouri at Kansas City School of Medicine
Joseph A Salomone, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gino A Farina, MD, Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and 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 College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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