SCLERITIS:Scleritis can be classified as anterior or posterior. Anterior scleritis is divided into sectoral, diffuse, nodular and necrotizing subtypes. Patients present with deep, constant pain in the involved eye. The disease can be bilateral in 50% of patients. It occurs predominantly in women and varies from mild forms to very severe forms that can destroy the eye. With active inflammation, the sclera has a violaceous hue best seen in natural sunlight. Engorgement of the deep vascular plexus is evident, as shown in the slide; the engorged vessels do not move when the overlying tissues are moved with a cotton-tipped applicator. Nodular anterior scleritis is most commonly seen in association with rheumatoid arthritis. The more destructive necrotizing scleritis can be associated with substantial loss of vision. The patient's life expectancy has been shown to be adversely affected by uncontrolled associated systemic autoimmune disease.Posterior scleritis almost always present with pain, tenderness, and proptosis. Choroidal folds, exudative retinal detachment and papilledema can also occur.Complications of scleritis include keratitis, uveitis, cataract, glaucoma, scleral thinning, marginal keratolysis and scleral perforation. The disease can occur as an isolated phenomenon or in association with various systemic autoimmune disease, such as rheumatoid arthritis, Wegener's granulomatosis, polyarteritis nodosa, systemic lupus erythematosus, herpes zoster ophthalmicus, syphilis, tuberculosis and gout. Milder cases respond to topical steroid therapy. Although definitive treatment varies according to cause, treatment sometimes involves nonsteroidal anti-inflammatory agents, systemic steroids, and, for the progressive cases, immunosuppressive agents. Appropriate treatment of associated systemic autoimmune diseases is also important.
EPISCLERITIS:
Episcleritis is a self-limited disease generally seen in young to middle-aged adults. It consists of inflammation and vasodilation of the
episclera and is not usually associated with any systemic disease. Inflammed
episcleral vessels are seen focally in one or both eyes, but they also can occur in a generalized pattern. Unlike
scleritis, episcleritis does not usually cause significant ocular pain or tenderness, and it resolves without treatment in most cases. If patients are symptomatic, this condition can be treated with topical nonsteroidal anti-inflammatory agents, vasoconstrictors, or rarely, low-dose topical corticosteroids.
