Severity of Scleritis and Episcleritis
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We retrospectively examined 52 patients (60 eyes) with episcleritis and scleritis. Their mean ages were 57 and 47 years, respectively. Slight female predominance was noted. Most patients had unilateral involvement. The ocular symptoms at the initial visit were redness and ocular pain. Some eyes with scleritis were complicated with uveitis, corneal lesions, and elevated intraocular pressure. In most affected eyes, corticosteroid eyedrops alone resolved the disease. We believe that in addition to ophthalmological examinations, standard physical and specific laboratory investigations should be performed in patients with episcleritis and scleritis.
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Purpose: Episcleritis and scleritis, considered as different forms of the same spectrum of disease, are clinically distinct, having different prognosis and requiring different management. They participate in a variety of systemic diseases, particularly in connective tissue disorders. As they are uncommon disorders, documentation of clinical experience with them is limited. In this study, the clinical profile and associated disorders of episcleritis and scleritis were studied. Methodology: Detailed clinical history was taken in every patient relating to ocular and systemic disorders. Ocular and systemic examinations were done in all patients. Essential investigations pertaining to the cases were done. The patients were followed up throughout the course of the study for a variable period. Results: One-fourth of episcleritis cases were of nodular type. All the six cases of scleritis were of anterior type. Episcleritis showed a peak age incidence in the third decade of life, whereas scleritis in the fourth decade. Episcleritis occurred slightly more commonly in females than males. Scleritis showed equal sex distribution. Fifty-five percent of episcleritis patients presented within 3rd week of onset of symptoms, whereas majority of scleritis patients presented during 3rd week of onset. Twenty five percent of episcleritis patients had recurrent disease. One out of 20 cases of episcleritis and one out of six cases of scleritis patients had an associated systemic disorder. In 45% of episcleritis patients, artificial tears were sufficient for treatment. In 15% of cases oral nonsteroidal anti-inflammatory drug (NSAID) was required for controlling their episcleral inflammation. In 5 out of 6 cases of scleritis, oral NSAID was sufficient for controlling inflammation. None of the episcleritis patients had a decreased best corrected visual acuity (BCVA). Whereas one-third of scleritis patients had a fall in BCVA. Conclusion: Episcleritis is a benign, self-limiting, and recurrent disorder which typically affects young adults. Scleritis of whatever variety is a serious condition and usually affects the older age group. Episcleritis patients do not develop any sight-threatening complications. Whereas a half of scleritis patients develop ocular complications, which are usually severe and sight threatening. In majority of episcleritis patients, topical medication will suffice. All patients with scleritis must be treated with systemic anti-inflammatory medications.
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Purpose : To evaluate the clinical features of the patients with episcleritis and scleritis. Methods : Retrospective chart review was performed for above patients that had been followed from 1986. 8. 8 to 2001. 6. 4. Results : The number of patients with episcleritis was 17 (49%) and that of scleritis was 18 (51%). Ocular complication occurred in 59% of patients with episcleritis and 72% of patients with scleritis. Keratitis was the most common ocular complication. No patient with episcleritis had a decrease in visual acuity, whereas 33% of patients with scleritis did. Systemic diseases were found in 69% of episcleritis whereas 77% of patients with scleritis associated with systemic diseases. Rheumatoid arthritis was the most common one in both groups of patients. Conclusions : Ocular complications, systemic diseases, and decrease in visual acuity are associated more of commonly with scleritis than episcleritis. When scleritis is suspected, careful examinations for associated ocular complications should be performed and be followed with history taking and evaluation for associated systemic disease.
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Purpose To evaluate demographic characteristics, clinical features, systemic disease associations, visual outcomes, and treatment modalities of patients with episcleritis and scleritis in an Italian tertiary care referral center. Methods Data from 25 patients with episcleritis and from 85 patients with scleritis followed from 2003 to 2012 were retrospectively evaluated. The main outcome measures were demographics, ocular disease characteristics, presence of systemic associated disease, treatment regimen, and follow-up period. Results Episcleritis and scleritis were found bilaterally in 24% and 31% of patients, respectively (p<0.521). The episcleritis was diffuse in 15 and focal in 10 patients, while the scleritis was diffuse in 49, nodular in 28, necrotizing in 6, and posterior in 2 patients. Anterior uveitis (4% vs 31%; p<0.006), peripheral ulcerative keratitis (0% vs 14%; p<0.167), ocular hypertension (0% vs 7%; p<0.333), and a decrease in visual acuity (4% vs 19%; p<0.112) were encountered as ocular complications in patients with episcleritis and patients with scleritis, respectively. An associated systemic disease was found in 20% and 52% of patients with episcleritis and patients with scleritis (p<0.004). Among patients with episcleritis, 76% required topical corticosteroid treatment to achieve disease resolution, 16% oral nonsteroidal anti-inflammatory drugs (NSAIDs), and 8% antivirals; 39% of patients with scleritis required systemic NSAIDs, 12% oral corticosteroids, 34% immunosuppressive drugs, and 15% antibiotics or antivirals. Conclusions The importance of differentiating scleritis from episcleritis is remarkable given the significant difference in the degree of ocular complications and associated systemic diseases between these ocular conditions. Prompt diagnosis, systemic assessment, and treatment are fundamental in all patients with scleral inflammation.
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From the earliest available descriptions of episcleritis (Slade, 1838; Rognetta, i844; Desmarres, 1847) a confusion has existed between scleritis and episcleritis.This has led to contradictory views on the relative severity and prognosis of these conditions, and the erroneous belief that episcleritis is accompanied by serious complications (Viswaling- ham, 1936; Wood, 1936; Mann and Markson, I950; Clavel and Teulieres, 1958).While Slade (I838), Rognetta (i844), and Desmarres (I847), thought Material Using the above classification, patients were distributed as in Table I.Normal anatomy Before considering the criteria by which the differential diagnosis is reached it is necessary to.
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Coronavirus disease (COVID-19) vaccines have been reported to have ocular side effects including scleritis and episcleritis.To report scleritis and episcleritis within a month following administration of COVID-19 vaccine.Retrospective case series.15 eyes of 12 consecutive patients with scleritis and episcleritis from March 2021 to September 2021 were included. The mean time of onset of symptoms in patients with scleritis was 15.7 days (range, 4-30) and for episcleritis it was 13.2 days (range 2-30). Patients received COVISHIELD™ (10 patients) and COVAXIN™ (2 patients). Five patients had denovo inflammation and seven had recurrent inflammation. Episcleritis patients were treated with topical steroids and systemic COX2 inhibitors while patients with scleritis were treated with topical steroids/oral steroids/antiviral medications depending on the aetiology.Scleritis and episcleritis following COVID-19 vaccination are milder and do not require intensive immunosuppression except in rare cases.
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Episcleritis and scleritis are two common inflammatory disorders encountered by primary care practitioners. Although episcleritis is a self-limited disease that usually resolves within 2 to 3 weeks, severe symptoms may require the use of topical steroids or, in recalcitrant cases, nonsteroidal anti-inflammatory agents (NSAIAs). Scleritis is a painful, generalized inflammation of the eye that is often associated with systemic disease. The necrotizing form of scleritis is the most serious, requiring aggressive treatment with NSAIAs and systemic steroids. Significant sequelae of scleritis include uveitis, glaucoma, cataract, and retinal detachment.
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