Scleritis is an inflammatory condition affecting the outer shell of the eye (sclera) that may be associated with a number of systemic inflammatory diseases. The process is often acutely painful and the ocular disease can be significant due to complications including decreased vision, uveitis, glaucoma and rarely, globe perforation.
The disease can be classified in numerous ways: anterior or posterior, nodular or diffuse, necrotizing or non-necrotizing, and infectious or non-infectious. Anterior, non-necrotizing, non-infectious scleritis is the most common form. Scleritis can be unilateral or bilateral, and is usually exquisitely painful.
Systemic disease associations of scleritis include rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease (IBD), and multiple forms of systemic vasculitis.1
Often, the underlying uveal tissue is visible through the thinned sclera giving it a blue-gray to brown appearance.
An infectious cause is responsible for about 5–10% of cases of anterior scleritis. The infecting organisms include bacteria, viruses, parasites, or fungi, and trauma.
Scleral nodule caused by nematode Onchocerca lupi
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Scleritis is typically managed but generally requires long-term therapy. Treatment is with aggressive local and systemic antibiotics as well as surgical debridement, corticosteroids, azathioprine, chlorambucil, and cyclosporine. Potential adverse effects associated with the use of topical corticosteroids include impaired wound healing and corneal degeneration. The outcome of infectious scleritis is generally worse than with non-infectious scleritis.3
- Pharmacotherapy of Scleritis: Current Paradigms and Future Directions Robert M. Beardsley,1 Dr. Eric B. Suhler,1,2 Dr. James T. Rosenbaum,1,3 and Phoebe Lin1 Expert Opin Pharmacother. 2013 Mar; 14(4): 411–424.
- Clinical case presentation and a review of the literature of canine onchocercosis by Onchocerca lupi in the United States
Domenico Otranto,corresponding author Alessio Giannelli, Nicole Scotty Trumble, Matt Chavkin, Gavin Kennard, Maria Stefania Latrofa, Dwight D Bowman, Filipe Dantas-Torres, and Mark L Eberhard Parasit Vectors. 2015; 8: 89.
- Clinical Atlas of Canine and Feline Ophthalmic Disease. Douglas W. Esson