Atlas of Ophthalmology

Nodular Scleritis (Colour Photography of Anterior Segment)

Sclera -> Scleritis -> Anterior Scleritis
Patient: 55 years of age, female, BCVA 1.0 at OD, 1.0 at OS; IOP 18 mmHg at OD, 20 mmHg at OS. Ocular Medical History: since two weeks red and painful left eye, no decrease of vision. General Medical History: CRP 1,4 mg%, no sign of sarcoidosis in x-ray. Main Complaint: pain at OS. Purpose: showing scleral nodule. Methods: Colour photography. Findings: Along with areas of diffuse scleral inflammation, a discrete, raised, scleral nodule is seen near the limbus at the 3 o’clock position. Discussion: Nodular scleritis can present as isolated condition or as part of a systemic inflammatory or infectious disorder. It is a serious ocular condition that can result in vision loss. Two-thirds of patients with non-infectious scleritis require systemic glucocorticoid therapy, and one fourth need a glucocorticoid-sparing agent, as well. Jabs et al (1) reported in a retrospective study of 97 patients with scleritis, that 30% required nonsteroidal anti-inflammatory drugs (NSAIDs) alone, 31% required oral glucocorticoids, and 26% required immunosuppressive drugs in addition to glucocorticoids to control their disease. Nodular anterior scleritis responded more often to NSAIDs (57%), whereas necrotizing scleritis often required systemic immunosuppressive drugs (70%). Scleritis can occur in any age group but usually presents between ages 30 and 50 and women are affected approximately twice more often than men. There is no racial or geographic predilection. There is no known HLA association. The prevalence of scleritis in the general population is estimated to be 6 cases per 100,000 people. It has been described up to 7% of those with Wegener’s granulomatosis. Fong et al (2) discussed the pathogenesis of scleritis. They found that the data available support an important role for T cells in the inflammatory process. Inflammatory cells, mostly T cells and macrophages, are found on biopsy specimens. Literature: (1) Jabs DA, Mudun A, Dunn JP, Marsh MJ. Episcleritis and scleritis: clinical features and treatment results. Am J Ophthalmol. 2000;130(4):469–76. (2) Fong LP, Sainz de la Maza M, Rice BA, Kupferman AE, Foster CS. Immunopathology of scleritis. Ophthalmology. 1991;98(4):472–9.

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