What Is Episcleritis?
Scleritis is a scleral infectious disease with red eyes and decreased vision as the primary symptoms and severe eye pain. Also known as deep scleritis. Rare than superficial scleritis. Urgent onset, often accompanied by cornea and uveitis, with poor prognosis. It can be divided into anterior scleritis and posterior scleritis according to the disease site. More common in women, eyes can occur sequentially or simultaneously.
Basic Information
- nickname
- Deep scleritis
- English name
- scleritis
- Visiting department
- Ophthalmology
- Multiple groups
- female
- Common locations
- eye
- Common causes
- Mainly caused by endogenous antigen-antibody immune complex
- Common symptoms
- Severe eye pain, decreased vision, scleral congestion, etc.
Causes of scleritis
- It is mainly caused by endogenous antigen-antibody immune complexes. It is common in connective tissue diseases such as rheumatoid arthritis, Wegener's granulomatosis, recurrent polychondritis, systemic lupus erythematosus, and Reiter disease. After a viral infection, syphilis, gout, or eye surgery.
Clinical manifestations of scleritis
- Anterior scleritis
- The lesion is located in front of the equator. Both eyes developed successively and the eye pain was severe. It lasts for weeks, and the delay can be months or even years. Can be complicated by keratitis, uveitis, cataracts, and increased intraocular pressure. Can be divided into three categories:
- (1) Nodular scleritis The sclera in the lesion area is purplish red and congested, the inflammation infiltrates and swells, and the nodule-like hump is firm, tender, and there may be multiple nodules.
- (2) Diffuse scleritis The sclera is diffusely congested, the bulbar conjunctiva is edema, and the sclera is characteristically blue.
- (3) Necrotic scleritis is more destructive and often causes inflammation of visual impairment. Eye pain is obvious, and early local scleral inflammatory plaques, and the marginal inflammation is heavier than the center. Advanced scleral necrosis becomes thinner, sees choroid, and even perforates. Lesions can spread rapidly and backward. After the inflammation subsided, the sclera was blue-gray with large blood vessels surrounding the lesion. It is often accompanied by severe autoimmune diseases such as vasculitis.
- 2. Posterior scleritis
- Rarely, it is a granulomatous inflammation located in the sclera behind the equator. Eye pain and decreased vision occurred to varying degrees. There was no significant change in the anterior segment. May be slightly jealous. The posterior segment showed mild vitreitis, edema of the optic disc (papillary optic disc), serous retinal detachment, and choroidal folds.
Scleritis examination
- Physical examination
- Focus on changes in the sclera, as well as changes in the conjunctiva, cornea, uvea, omentum, and optic disc. The congestion and edema of superficial scleritis are confined to the surface of the sclera and do not involve the underlying sclera, which can be clearly identified by the slit lamp beam.
- 2. Auxiliary inspection
- Choices include full blood cell count, ESR, rheumatoid factor (RF), antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), and serum uric acid detection. For posterior scleritis, B-ultrasound, CT scan, or MRI are available.
Scleritis Treatment
- Anti-inflammatory treatment
- Apply glucocorticoids and non-steroidal anti-inflammatory drugs to the eyes or the whole body. If the effect is not good, immunosuppressants can be added.
- 2. with ciliary muscle spasm
- Atropine can be used to dilate the ciliary muscles.
- 3. Severe cases
- It is prohibited to inject glucocorticoids under the conjunctiva, behind the ball, or around the ball to prevent scleral perforation in the avascular and uveal areas.
- 4. Surgery
- For patients with scleral necrosis and perforation, allogeneic scleral transplantation can be tried.
- First of all, the above-mentioned treatment should be performed on the basis of standardized treatment of the primary disease.