The Sclera pp 137-170 | Cite as

Pathology in Scleritis: The Massachusetts Eye and Ear Infirmary Experience

  • C. Stephen Foster
  • Maite Sainz de la Maza


The histopathological aspects of scleral inflammation have been studied extensively in the past. Although certain inferences can be drawn from these descriptions, terms such as “chronic nonspecific inflammation,” or even “chronic granulomatous inflammation,” only camouflaged our ignorance about the possible pathogenic roles that cells might play. Even sophisticated techniques such as electron microscopy provided limited insights into the delineation of the distinctive composition of the cellular infiltrates as well as into the components of the matrix during inflammation. It was not until the relatively recent development of immunohistochemistry, particularly the exploitation of monoclonal antibody technology, that the etiology and pathogenesis of scleral diseases have become less obscure and intimidating. Our ability to characterize cells and determine extracellular matrix changes during inflammatory reactions contributes to the understanding of mechanisms of lesion production and thereby to the development of treatment options most likely to succeed. Thus it is possible to distinguish between T and B lymphocytes, to determine mononuclear subsets (T helper, T cytotoxic/suppressor, natural killer, macrophages, and Langerhans’ cells), and to detect HLA-DR glycoproteins in scleral inflammation; it is now possible to identify and further characterize different types of components of extracellular matrix (collagen, glycosaminoglycans, and glycoproteins) during inflammatory reactions; it is also possible to localize specific antigens (herpes simplex virus) in inflamed tissue.


Herpes Zoster Rheumatoid Vasculitis Scleral Tissue Color Insert Chronic Granulomatous Inflammation 
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  1. 1.
    Nathan CF: Secretory products of macrophages. J Clin Invest 79: 319, 1987.PubMedGoogle Scholar
  2. 2.
    Adams DO, Hamilton TA: Phagocytic cells: cytotoxic activities of macrophages. In Gallin JI, Goldstein IM, Snyderman R (Eds): Inflammation: Basic Principles and Clinical Correlates. Raven, New York, 1988, pp 471–492.Google Scholar
  3. 3.
    Tse HY, Rosenthal AS: Lymphocytes: interaction with macrophages. In Gallin JI, Goldstein IM, Snyderman R (Eds): Inflammation: Basic Principles and Clinical Correlates. Raven, New York, 1988, pp 631–649.Google Scholar
  4. 4.
    Adams DO, Hamilton TA: Molecular bases of signal transduction in macrophage activation induced by IFN gamma and by second signals. Immunol Rev 97: 1, 1987.Google Scholar
  5. 5.
    Adams DO: The biology of the granuloma. In Ioachim HL (Ed): Pathology of Granulomas. Raven, New York, 1983, pp 1–20.Google Scholar
  6. 6.
    Adams DO: The granulomatous inflammatory response: a review. Am J Pathol 84: 164, 1976.PubMedGoogle Scholar
  7. 7.
    Postlethwaite AE, Jackson BK, Beachey EH, Kang AH: Formation of multinucleated giant cells from human monocyte precursors. J Exp Med 155: 168, 1982.PubMedGoogle Scholar
  8. 8.
    Unanue ER, Benacerraf B: Immunological events in experimentally induced granulomas. Am J Pathol 71: 349, 1973.PubMedGoogle Scholar
  9. 9.
    Weinberg JB, Hobbs MM, Misunokis MA: Recombinant human gamma interferon induces human monocyte polykaryon formation. Proc Natl Acad Sci USA 81: 4554, 1984.PubMedGoogle Scholar
  10. 10.
    McInnes A, Rennick DM: Interleukin-4 induces cultured monocytes/macrophages to form giant multinucleated cells. J Exp Med 167: 598, 1988.PubMedGoogle Scholar
  11. 11.
    Neumann E: Die Picrocarminforbung and ihre Anwendung auf die Entzundungslehre. Archiv für mikroscopische Anatomie, and Entwicklungsmechanik 18: 130, 1880.Google Scholar
  12. 12.
    Gitlin D, Craig JM, Janeway CA: Studies on the nature of fibrinoid and the collagen diseases. Am J Pathol 33: 55, 1957.PubMedGoogle Scholar
  13. 13.
    Warren BA, Vales O: The release of vesicles from platelets following adhesion to vessel walls in vitro. Br J Exp Pathol 53: 206, 1972.PubMedGoogle Scholar
  14. 14.
    Johnsen ULH, Lyberg T, Galdal KS, Prydz H: Platelets stimulate thromboplastin synthesis in human endothelial cells. Thromb Haemost 49: 69, 1983.PubMedGoogle Scholar
  15. 15.
    Annamalai AE, Stewart GJ, Hansel B, Memoli M, Chiu HC, Manuel DW, Doshi K, colman RW: Expression of factor V on human umbilical vein endothelial cells is modulated by cell injury. Arteriosclerosis 6: 196, 1986.PubMedGoogle Scholar
  16. 16.
    Groenewegen G, Buurman WA: Vascular endothelium cells present alloantigens to un-primed lymphocytes. Scand J Immunol 19: 269, 1984.PubMedGoogle Scholar
  17. 17.
    Hirschberg H, Bergh OJ, Thorsby E: Antigen-presenting properties of human vascular endothelial cells. J Exp Med 152: 249, 1980.Google Scholar
  18. 18.
    Wagner CR, Vetto RM, Burger DR: The mechanism of antigen presentation by endothelial cells Immunobiology 168: 453, 1984.Google Scholar
  19. 19.
    Masuyama J, Minato N, Kano S: Mechanisms of lymphocyte adhesion to human vascular endothelial cells in culture. T lymphocyte adhesion to endothelial cells through endothelial HLA-DR antigens induced by gamma interferon. J Clin Invest 77: 1596, 1986.PubMedGoogle Scholar
  20. 20.
    Folkman J: Angiogenesis: initiation and control. Ann NY Acad Sci 401: 212, 1983.Google Scholar
  21. 21.
    Watson PG: Diseases of the sclera and episclera. In Tasman W, Jaeger EA (Eds): Duane’s Clinical Ophthalmology, rev ed. Lippincott, Philadelphia, 1989, pp 13–17.Google Scholar
  22. 22.
    McCarthy JL: Episcleral nodules and erythema nodosum. Am J Ophthalmol 51: 60, 1961.PubMedGoogle Scholar
  23. 23.
    Edström G, Osterlind G: Case of nodular rheumatic episcleritis. Acta Ophthalmol 26: 1, 1948.Google Scholar
  24. 24.
    Mundy WL, Howard RM, Stillman PM, Bevans M: Cortisone therapy in the case of rheumatoid nodules of the eye in rheumatoid arthritis. Arch Ophthalmol 45: 531, 1951.Google Scholar
  25. 25.
    Fienberg R, Colpoys FL: Involution of rheumatoid nodules treated with cortisone and of non-treated rheumatoid nodules. Am J Pathol 27: 925, 1951.PubMedGoogle Scholar
  26. 26.
    Ferry AP: Histopathology of rheumatoid episcleral nodules, an extra-articular manifestation of rheumatoid arthritis. Arch Ophthalmol 82: 77, 1969.PubMedGoogle Scholar
  27. 27.
    Young RD, Watson PG: Microscopical studies of necrotising scleritis. I. Cellular aspects. Br J Ophthalmol 68: 770, 1984.PubMedGoogle Scholar
  28. 28.
    Fong LP, Sainz de la Maza M, Rice BA, Foster CS: Immunopathology of scleritis. Ophthalmology 98: 472, 1991.PubMedGoogle Scholar
  29. 29.
    Sevel D: Necrogranulomatous scleritis. Am J Ophthalmol 64: 1125, 1967.PubMedGoogle Scholar
  30. 30.
    Rao NA, Marak GE, Hydayat AA: Necrotizing scleritis. A clinicopathologic study of 41 cases. Ophthalmology 92: 1542, 1985.PubMedGoogle Scholar
  31. 31.
    Hatsuda T, Tanaka J: Bilateral necrotizing scleritis. Am J Ophthalmol 86: 710, 1978.PubMedGoogle Scholar
  32. 32.
    Hogan MJ, Zimmerman LE: Ophthalmic Pathology. W.B. Saunders, Philadelphia, 1962, pp 337–339.Google Scholar
  33. 33.
    Sainz de la Maza M, Tauber J, Foster CS: Scleral grafting for necrotizing scleritis. Ophthalmology 96: 306, 1989.Google Scholar
  34. 34.
    Sellers A, Murphy G: Collagenolytic enzymes and their naturally occurring inhibitors. In Hall DA, Jackson DS (Eds): International Review of Connective Tissue Research, Vol 9. Academic Press, New York, 1981, p 151.Google Scholar
  35. 35.
    Young RD, Watson PG: Microscopical studies of necrotising scleritis. II. Collagen degradation in the scleral stroma. Br J Ophthalmol 68: 781, 1984.PubMedGoogle Scholar
  36. 36.
    Watson PG, Young RD: Changes at the periphery of a lesion in necrotising scleritis: anterior segment fluorescein angiography correlated with electron microscopy. Br J Ophthalmol 69: 656, 1985.PubMedGoogle Scholar
  37. 37.
    Young RD, Powell J, Watson PG: Ultrastructural changes in scleral proteoglycans precede destruction of the collagen fibril matrix in necrotizing scleritis. Histopathology 12: 75, 1988.PubMedGoogle Scholar
  38. 38.
    Montes GS, Bezerra MSF, Junqueira LCU: Collagen distribution in tissues. In Ruggeri A, Motta PM (Eds): Ultrastructure of the Connective Tissue Matrix. Martinius Nijhoff, Boston, 1984, Chap 3.Google Scholar
  39. 39.
    Watson PG: Doyne Memorial Lecture, 1982. The nature and the treatment of scleral inflammation. Trans Ophthalmol Soc UK 102: 257, 1982.PubMedGoogle Scholar
  40. 40.
    Sainz de la Maza M, Foster CS: Necrotizing scleritis after ocular surgery. A clinicopathologic study. Ophthalmology 98: 1720, 1991.Google Scholar
  41. 41.
    Bloomfield SE, Becker CG, Christian CL, Nauheim JS: Bilateral necrotizing scleritis with marginal corneal ulceration after cataract surgery in a patient with vasculitis. Br J Ophthalmol 64: 170, 1980.PubMedGoogle Scholar
  42. 42.
    Calthorpe CM, Watson PG, McCartney ACE: Posterior scleritis: a clinical and histopathological survey. Eye 2: 267, 1988.PubMedGoogle Scholar
  43. 43.
    Wilhelmus KR, Watson PG, Vasavada AR: Uveitis associated with scleritis. Trans Ophthalmol Soc UK 101: 351, 1981.PubMedGoogle Scholar
  44. 44.
    Frayer WC: The histopathology of perilimbal ulceration in Wegener’s granulomatosis. Arch Ophthalmol 64: 58, 1960.PubMedGoogle Scholar
  45. 45.
    Wilhelmus KR, Grierson I, Watson PG: Histopathologic and clinical associations of scleritis and glaucoma. Am J Ophthalmol 91: 697, 1981.PubMedGoogle Scholar
  46. 46.
    Bertelsen TI: Acute sclerotenonitis and ocular myositis complicated by papillitis, retinal detachment and glaucoma. Acta Ophthalmol 38: 136, 1960.Google Scholar
  47. 47.
    Fraunfelder FT, Watson PG: Evaluation of eyes enucleated for scleritis. Br J Ophthalmol 60: 227, 1976.PubMedGoogle Scholar
  48. 48.
    Fauci AS, Haynes BF, Katz P: The spectrum of vasculitis: clinical, pathologic, immunologic, and therapeutic considerations. Ann Intern Med 89: 660, 1978.PubMedGoogle Scholar
  49. 49.
    McCluskey RT, Fienberg R: Vasculitis in primary vasculitides, granulomatoses, and connective tissue diseases. Hum Pathol 14: 305, 1983.PubMedGoogle Scholar
  50. 50.
    Moskowitz RW, Baggenstonss AH, Slocumb CH: Histopathologic classification of periarteritis nodosa: a study of 56 cases confirmed at necropsy. Proc Staff Meet Mayo Clin 38: 345, 1963.PubMedGoogle Scholar
  51. 51.
    Zeek PM: Periarteritis nodosa and other forms of necrotizing angiitis. N Engl J Med 248: 764, 1953.PubMedGoogle Scholar
  52. 52.
    Cohen RD, Conn DL, Ilstrup DM: Clinical features, prognosis, and response to treatment in polyarteritis. Mayo Clin Proc 55: 146, 1980.PubMedGoogle Scholar
  53. 53.
    Cogan DG: Corneoscleral lesions in periarteritis nodosa and Wegener’s granulomatosis. Trans Am Acad Ophthalmol 53: 321, 1955.Google Scholar
  54. 54.
    Patalamo VJ, Sommers SC: Biopsy diagnosis of periarteritis nodosa. Arch Pathol 72: 1, 1961.Google Scholar
  55. 55.
    Goar EL, Smith LS: Polyarteritis nodosa of the eye. Am J Ophthalmol 35: 1619, 1952.PubMedGoogle Scholar
  56. 56.
    Goldstein I, Wexler D: The ocular pathology of periarteritis nodosa. Arch Ophthalmol 2: 288, 1929.Google Scholar
  57. 57.
    Helpern M, Trubeck M: Necrotizing arteritis and subacute glomerulonephritis in gonococcic endocarditis. Arch Pathol 15: 35, 1933.Google Scholar
  58. 58.
    Boeck J: Ocular changes in periarteritis no-dosa. Am J Ophthalmol 42: 567, 1956.PubMedGoogle Scholar
  59. 59.
    Sheehan B, Harriman DG, Bradshaw JP: Polyarteritis nodosa with ophthalmic and neurological complications. Arch Ophthalmol 60: 537, 1958.Google Scholar
  60. 60.
    Diaz-Perez JL, Winkelmann RK: Cutaneous periarteritis nodosa. Arch Dermatol 110: 407, 1974.PubMedGoogle Scholar
  61. 61.
    Sack M, Cassidy JT, Bole GG: Prognostic factors in polyarteritis. J Rheumatol 2: 411, 1975.PubMedGoogle Scholar
  62. 62.
    Dyck PJ, Conn DL, Okazaki H: Necrotizing angiopathic neuropathy: three-dimensional morphology of fiber degeneration related to sites of occluded vessels. Mayo Clin Proc 47: 461, 1972.PubMedGoogle Scholar
  63. 63.
    Churg J, Strauss L: Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol 27: 277, 1951.Google Scholar
  64. 64.
    Dicken CH, Winkelmann RK: The Chung-Strauss granuloma: cutaneous, necrotizing, palisading granuloma in vasculitis syndromes. Arch Pathol Lab Med 102: 576, 1978.PubMedGoogle Scholar
  65. 65.
    Strauss L, Churg J, Zak FG: Cutaneous lesions of allergic granulomatosis. A histopathologic study. J Invest Dermatol 17: 349, 1951.PubMedGoogle Scholar
  66. 66.
    Crotty CP, Deremee RA, Winkelmann RK: Cutaneous clinicopathologic correlation of allergic granulomatosis. J Am Acad Dermatol 5: 571, 1981.PubMedGoogle Scholar
  67. 67.
    Chumbley LC, Harrison EG Jr, Deremee RA: Allergic granulomatosis and angiitis (ChurgStrauss syndrome). Report and analysis of 30 cases. Mayo Clin Proc 52: 477, 1977.PubMedGoogle Scholar
  68. 68.
    Lanham JG, Elkon KB, Pusey CD, Huges GR: Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine (Baltimore) 63: 65, 1984.Google Scholar
  69. 69.
    Cury D, Breakey AS, Payne BF: Allergic granulomatous angiitis associated with uveoscleritis and papilledema. Arch Ophthalmol 55: 261, 1950.Google Scholar
  70. 70.
    Nissim F, Von der Valde J, Czernobilsky B: A limited form of Churg-Strauss syndrome. Arch Pathol Lab Med 106: 305, 1982.PubMedGoogle Scholar
  71. 71.
    Klinger H: Grenzformen der Periarteritis no-dosa. Frankfurt Z Pathol 42: 455, 1931.Google Scholar
  72. 72.
    Wegener F: Über generalisierte, septische Gefäserkrankungen. Verh Dtsch Ges Pathol 29: 202, 1936.Google Scholar
  73. 73.
    Wegener F: Über eine eigenartige rhino-gene Granulomatose mit besonderer Beteilingung des Arteriensystems und der Nieren. Beitr Pathol Anat Allg Pathol 102: 36, 1939.Google Scholar
  74. 74.
    Godman GC, Churg J: Wegener’s granulomatosis: pathology and review of the literature. Arch Pathol 58: 533, 1954.Google Scholar
  75. 75.
    Fauci AS, Wolff SM: Wegener’s granulomatosis: studies in eighteen patients and a review of the literature. Medicine (Baltimore) 52: 535, 1973.Google Scholar
  76. 76.
    Wolff SM, Fauci AS, Horn RG, Dale DC: Wegener’s granulomatosis. Ann Intern Med 81: 513, 1974.PubMedGoogle Scholar
  77. 77.
    Carrington CB, Leibow AA: Limited forms of angiitis and granulomatosis of Wegener’s type. Am J Med 41: 497, 1966.PubMedGoogle Scholar
  78. 78.
    Niffenegger JH, Jakobiec FA, Raizman MB, Foster CS: Pathologic diagnosis of very limited (ocular or orbital) Wegener’s granulomatosis (in press).Google Scholar
  79. 79.
    Walton EW: Giant cell granuloma of the respiratory tract (Wegener’s granulomatosis). Br Med J 2: 265, 1958.PubMedGoogle Scholar
  80. Fahey J, Leonard E, Churg J, et al.: Wegener’s granulomatosis. Am J Med 17:168, 1973.Google Scholar
  81. 81.
    Haynes BF, Fishman ML, Fauci AS, Wolff SM: The ocular manifestations of Wegener’s granulomatosis. Fifteen years’ experience and review of the literature. Am J Med 63: 131, 1977.PubMedGoogle Scholar
  82. 82.
    Fauci AS, Haynes BF, Katz P, Wolff SM: Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients over 21 years. Ann Intern Med 98: 76, 1983.PubMedGoogle Scholar
  83. 83.
    Spalton DJ, Graham EM, Page NGR, Sanders MD: Ocular changes in limited forms of Wegener’s granulomatosis. Br J Ophthalmol 65: 553, 1981.PubMedGoogle Scholar
  84. 84.
    Bullen CL, Liesegang TJ, McDonald TJ, DeRemee RA: Ocular complications of Wegener’s granulomatosis. Ophthalmology 90: 279, 1983.PubMedGoogle Scholar
  85. 85.
    Cutler WM, Blatt IM: The ocular manifestations of lethal midline granuloma (Wegener’s granulomatosis). Am J Ophthalmol 42: 21, 1956.PubMedGoogle Scholar
  86. 86.
    Straatsma BR: Ocular manifestations of Wegener’s granulomatosis. Am J Ophthalmol 44: 789, 1957.PubMedGoogle Scholar
  87. 87.
    Coppeto JR, Yamase H, Monteiro MLR: Chronic ophthalmic Wegener’s granulomatosis. J Clin Neuro-ophthalmol 5: 17, 1985.Google Scholar
  88. 88.
    Brubacker R, Font T, Shepherd E: Granulomatous sclerouveitis. Regression of ocular lesions with cyclophosphamide and p’rednisone. Arch Ophthalmol 86: 517, 1971.Google Scholar
  89. 89.
    Sacks RD, Stock EL, Crawford SE, Greenwald MJ, O’Grady RB: Scleritis and Wegener’s granulomatosis in children. Am J Ophthalmol 111: 430, 1991.PubMedGoogle Scholar
  90. 90.
    Wegener F: About the so-called Wegener’s granulomatosis. Am J Med 19: 829, 1955.Google Scholar
  91. 91.
    Boudes P: Purely granulomatous Wegener’s granulomatosis: a new concept for an old disease. Semin Arthritis Rheum 19: 365, 1990.PubMedGoogle Scholar
  92. 92.
    Hu CH, O’Laughlin S, Winkelmann RK: Cutaneous manifestations of Wegener’s granulomatosis. Arch Dermatol 113: 175, 1977.PubMedGoogle Scholar
  93. 93.
    Frayer WC: The histopathology of perilimbal ulceration in Wegener’s granulomatosis. Arch Ophthalmol 64: 58, 1960.PubMedGoogle Scholar
  94. 94.
    Foster CS, Yee M: Corneoscleral manifestations of Graves’s disease, the acquired connective tissue disorders, and systemic vasculitis. Int Ophthalmol Clin 23 (1): 131, 1983.PubMedGoogle Scholar
  95. 95.
    Cohen-Tervaert JW, van der Woude FJ, Fauci AS, Ambrus JL, Velosa J, Keane WF, Meijers, van der Giessen M: Association between active Wegener’s granulomatosis and anticytoplasmic antibodies. Arch Intern Med 149: 2461, 1989.Google Scholar
  96. 96.
    Nölle B, Specks U, Lüdemann J, Rohrbach MS, DeRemee RA, Gross WL: Anticytoplasmic autoantibodies: their immunodiagnostic value in Wegener’s granulomatosis. Ann Intern Med 111: 28, 1989.PubMedGoogle Scholar
  97. 97.
    Soukiasian SH, Foster CS, Niles JL, Raizman MB: Diagnostic value of anti-neutrophil cytoplasmic antibodies (ANCA) in scleritis associated with Wegener’s granulomatosis. Ophthalmology 99: 125, 1992.PubMedGoogle Scholar
  98. 98.
    Kalina PH, Garrity JA, Herman DC, DcReemee RA, Specks U: Role of testing for anticytoplasmic autoantibodies in the differential diagnosis of scleritis and orbital pseudotumor. Mayo Clin Proc 65: 1110, 1990.PubMedGoogle Scholar
  99. 99.
    Rodnan GP, Schumacher HR, Zavifler NJ: Primer on the Rheumatic Diseases, 8th ed. Arthritis Foundation, Atlanta, GA, 1983, p 38.Google Scholar
  100. 100.
    Sokoloff L: The pathophysiology of peripheral blood vessels in collagen diseases. In Orbison JL, Smith DE (Eds): The Peripheral Blood Vessels. Williams & Wilkins, Baltimore, 1963, p 297.Google Scholar
  101. 101.
    Nowoslawski A, Brzosko WJ: Immunopathology of rheumatoid arthritis. II. The rheumatoid nodule (the rheumatoid granuloma). Pathol Eur 2: 302, 1967.PubMedGoogle Scholar
  102. 102.
    Harris ED Jr: A collagenolytic system produced by primary cultures of rheumatoid nodule tissue. J Clin Invest 51: 2973, 1972.PubMedGoogle Scholar
  103. 103.
    Sevel D: Rheumatoid nodule of the sclera. Trans Ophthalmol Soc UK 85: 357, 1965.PubMedGoogle Scholar
  104. 104.
    Abel T, Andrews B, Cunningham P, Brunner CM, Davis JS IV, Horwitz DA: Rheumatoid vasculitis: effect of cyclophosphamide on the clinical course and levels of circulating immune complexes. Ann Rheum Dis 93: 407, 1980.Google Scholar
  105. 105.
    Mongan ES, Cass RM, Jacox RF, Vaughan JH: A study of the relation of seronegative and seropositive rheumatoid arthritis to each other and to necrotizing vasculitis. Am J Med 47: 23, 1969.PubMedGoogle Scholar
  106. 106.
    Weinstein A, Peters K, Brown D, Bluestone R: Metabolism of the third component of complement (C3) in patients with rheumatoid arthritis. Arthritis Rheum 15: 49, 1972.PubMedGoogle Scholar
  107. 107.
    Conn DL, McDuffie FC, Dyck PJ• Immunopathologic study of sural nerves in rheumatoid arthritis. Arthritis Rheum 15: 135, 1972.PubMedGoogle Scholar
  108. 108.
    Weisman M, Zvaifler N: Cryoimmunoglobulinemia in rheumatoid arthritis. J Clin Invest 56: 725, 1975.PubMedGoogle Scholar
  109. 109.
    Qismorio F, Beardmore T, Kaufman R, Mongan ES: IgG rheumatoid factor and antinuclear antibodies in rheumatoid vasculitis. Clin Exp Immunol 52: 333, 1983.Google Scholar
  110. 110.
    Rapoport RJ, Kozin F, Mackel SE, Jordon RE: Cutaneous vascular immunofluorescence in rheumatoid arthritis. Correlation with circulating immune complexes and vasculitis. Am J Med 68: 325, 1980.PubMedGoogle Scholar
  111. 111.
    Scott DGI, Bacon PA, Tribe CR: Systemic rheumatoid vasculitis: a clinical and laboratory study of 50 cases. Medicine 60: 288, 1981.PubMedGoogle Scholar
  112. 112.
    Scott DGI, Bacon PA, Allen C, Elson CJ, Wallington T: IgG rheumatoid factor, complement, and immune complexes in rheumatoid synovitis and vasculitis: comparative and serial studies during cytotoxic therapy. Clin Exp Immunol 43: 54, 1981.PubMedGoogle Scholar
  113. 113.
    Sokoloff L, Bunim JJ: Vascular lesions in rheumatoid arthritis. J Chronic Dis 5: 668, 1957.PubMedGoogle Scholar
  114. 114.
    Douglas W: The digital artery lesion of rheumatoid arthritis. Ann Rheum Dis 24: 40, 1965.PubMedGoogle Scholar
  115. 115.
    Ferguson RH, Slocumb CH: Peripheral neuropathy in rheumatoid arthritis. Bull Rheum Dis 11: 251, 1961.PubMedGoogle Scholar
  116. 116.
    Hunder GG, McDuffie FC: Hypocomplementemia in rheumatoid arthritis. Am J Med 54: 461, 1973.PubMedGoogle Scholar
  117. 117.
    Collins DH: The subcutaneous nodule of rheumatoid arthritis. J Pathol Bacteriol 45: 97, 1937.Google Scholar
  118. 118.
    Bennett GA, Zeller JW, Bauer W: Subcutaneous nodules of rheumatoid arthritis and rheumatic fever: a pathologic study. Arch Pathol 30: 70, 1940.Google Scholar
  119. 119.
    Kaye BR, Kaye RL, Bobrove A: Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases. Am Rheum Dis 23: 345, 1964.Google Scholar
  120. 120.
    Swezey RL: Myocardial infarction due to rheumatoid arteritis. JAMA 199: 191, 1967.Google Scholar
  121. 121.
    Cobb S, Anderson F, Baurer W: Length of life and cause of death in rheumatoid arthritis. N Engl J Med 249: 553, 1953.PubMedGoogle Scholar
  122. 122.
    Jayson MI, Jones DE: Scleritis and rheumatoid arthritis. Ann Rheum Dis 5: 668, 1957.Google Scholar
  123. 123.
    Foster CS, Forstot SL, Wilson LA: Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis. Ophthalmology 91: 1253, 1984.PubMedGoogle Scholar
  124. 124.
    Pavan-Langston D: Varicella-zoster ophthalmicus. Int Ophthalmol Clin 15 (4): 171, 1975.PubMedGoogle Scholar
  125. 125.
    Ostler HB, Thygeson P: The ocular manifestations of herpes zoster, varicella, infectious mononucleosis, and cytomegalovirus disease. Sury Ophthalmol 21: 148, 1976.Google Scholar
  126. 126.
    Hedges TR III, Albert DM: The progression of the ocular abnormalities of herpes zoster; histopathologic observations in nine cases. Ophthalmology 89: 165, 1982.PubMedGoogle Scholar
  127. 127.
    Nanda M, Pflugfelder SC, Holland S: Mycobacterium tuberculosis scleritis. Am J Ophthalmol 108: 736, 1989.PubMedGoogle Scholar
  128. 128.
    Tamesis RR, Foster CS: Ocular syphilis. Ophthalmology 97: 1281, 1990.PubMedGoogle Scholar
  129. 129.
    Wilhelmus KR, Yokoyama CM: Syphilitic episcleritis and scleritis: Am J Ophthalmol 104: 595, 1987.PubMedGoogle Scholar
  130. 130.
    Reynolds MG, Alfonso E: Infectious scleritis and keratoscleritis: management and outcome. Am J Ophthalmol 112: 543, 1991.PubMedGoogle Scholar
  131. 131.
    Raber IM, Laibson PR, Kurz GH, Bernardino VB: Pseudomonas corneoscleral ulcers. Am J Ophthalmol 92: 353, 1981.PubMedGoogle Scholar
  132. 132.
    Codère F, Brownstein S, Jackson WB: Pseudomonas aeruginosa scleritis. Am J Ophthalmol 91: 706, 1981.PubMedGoogle Scholar
  133. 133.
    Alfonso E, Kenyon KR, Ormerod LD, Stevens R, Wagoner MD, Albert DM: Pseudomonas corneoscleritis. Am J Ophthalmol 103: 90, 1987.PubMedGoogle Scholar
  134. 134.
    Farrell PLR, Smith RE: Bacterial corneoscleritis complicating pterygium excision. Am J Ophthalmol 107: 515, 1989.PubMedGoogle Scholar
  135. 135.
    Altman AJ, Cohen EJ, Berger ST, Mondino BJ: Scleritis and Streptococcus pneumoniae. Cornea 10 (4): 341, 1991.PubMedGoogle Scholar
  136. 136.
    Friedman AH, Henkind P: Unusual causes of episcleritis. Trans Am Acad Ophthalmol Otolaryngol 78: 890, 1974.Google Scholar
  137. 137.
    Stenson S, Brookner A, Rosenthal S: Bilateral endogenous necrotizing scleritis due to Aspergillus oryzae. Ann Ophthalmol 14: 67, 1982.PubMedGoogle Scholar
  138. 138.
    Lindquist TD, Fritsche TR, Grutzmacher RD: Scleral ectasia secondary to Acanthamoeba keratitis. Cornea 9: 74, 1990.PubMedGoogle Scholar
  139. 139.
    Margo CE, Hidayat AA, Polack F: Ciliary body granuloma simulating malignant melanoma after herpes zoster ophthalmicus. Cornea 1: 147, 1982.Google Scholar
  140. 140.
    Esiri MM, Tomlinson AH: Herpes zoster: demonstration of virus in trigeminal nerve and ganglion by immunofluorescence and electron microscopy. J Neurol Sci 15: 35, 1972.PubMedGoogle Scholar
  141. 141.
    Nagashima K, Nakazawa M, Endo H: Pathology of the human spinal ganglia in varicellazoster virus infection. Acta Neuropathol 33: 105, 1975.PubMedGoogle Scholar
  142. 142.
    Hasegawa T: Further electron microscopic observations of herpes zoster virus. Arch Dermatol 103: 45, 1971.PubMedGoogle Scholar
  143. 143.
    Ruppenthal M: Changes in central nervous system in herpes zoster. Acta Neuropathol 52: 59, 1980.PubMedGoogle Scholar
  144. 144.
    Pavan-Langston D, McCulley J: Herpes zoster dendritic keratitis. Arch Ophthalmol 89: 25, 1973.PubMedGoogle Scholar
  145. 145.
    McCormick WF, Rodnitzky RL, Schochet SS Jr, McKee AP: Varicella-zoster encephalomyelitis: a morphologic and virologic study. Arch Neurol 21: 559, 1969.PubMedGoogle Scholar
  146. 146.
    Hogan EL, Krigman MR: Herpes zoster myelitis: evidence for viral invasion of the spinal cord. Arch Neurol 21: 559, 1969.Google Scholar
  147. 147.
    Ghatak NR, Zimmerman HM: Spinal ganglion in herpes zoster. A light and electron microscopic study. Arch Pathol 95: 411, 1973.PubMedGoogle Scholar
  148. 148.
    Bastian FO, Rabson AS, Yee CL, Trankla TS: Herpesvirus varicellae. Isolated from human dorsal root ganglia. Arch Pathol 97: 331, 1974.PubMedGoogle Scholar
  149. 149.
    Schwartz JN, Cashwell F, Hawkins HK, Klintworth GK: Necrotizing retinopathy with herpes zoster ophthalmicus: a light and electron microscopical study. Arch Pathol Lab Med 100: 386, 1976.PubMedGoogle Scholar
  150. 150.
    Witmer R, Iwamoto T: Electron microscope observation of herpes-like particles in the iris. Arch Ophthalmol 79:331, 1968; and Witmer R: Personal communication, 1980.Google Scholar
  151. 151.
    Weller TH, Witton HM, Bell EJ: The etiologic agents of varicella and herpes zoster. Isolation, propagation, and cultural characteristics in vitro. J Exp Med 108: 843, 1958.PubMedGoogle Scholar
  152. 152.
    Solomon AR, Rasmussen JE, Weiss JS: A comparison of the Tzanck smear and viral isolation in varicella and herpes zoster. Arch Dermatol 122: 282, 1986.PubMedGoogle Scholar
  153. 153.
    Gold E: Serologic and virus-isolation studies of patients with varicella or herpes-zoster infection. N Engl J Med 274: 181, 1966.PubMedGoogle Scholar
  154. 154.
    Lam MT, Pazin GJ, JA Armstrong, Ho M: Herpes simplex infection in acute myelogenous leukemia and other hematologic malignancies: a prospective study. Cancer 48: 2168, 1981.PubMedGoogle Scholar
  155. 155.
    Leming PD, Martin SE, Zwelling LA: Atypical herpes simplex (HSV) infection in a patient with Hodgkin’s disease. Cancer 54: 3043, 1984.PubMedGoogle Scholar
  156. 156.
    Orton PW, Huff JC, Tonnesen MG, Weston WL: Detection of a herpes simplex viral antigen in skin lesions of erythema multiforme. Ann Int Med 101: 48, 1984.PubMedGoogle Scholar
  157. 157.
    Foster CS, Fong LP, Azar D, Kenyon KR: Episodic conjunctival inflammation after Stevens—Johnson syndrome. Ophthalmology 95: 453, 1988.PubMedGoogle Scholar
  158. 158.
    Glassroth J, Robins AG, Snider DE Jr: Tuberculosis in the 1980’s. N Engl J Med 302: 1441, 1980.PubMedGoogle Scholar
  159. 159.
    Donahue HC: Ophthalmologic experience in a tuberculosis sanatorium. Am J Ophthalmol 64: 742, 1967.PubMedGoogle Scholar
  160. 160.
    Shumomura Y, Tader R, Yuam T: Ocular disorders in pulmonary tuberculosis. Folia Ophthalmol Jpn 30: 1973, 1979.Google Scholar
  161. 161.
    Phillips S, Williams ML, Maiden SD: Chronic miliary tuberculosis. Am Rev Tuberculosis 62: 549, 1950.Google Scholar
  162. 162.
    Bell GH: Report of a case of tuberculosis of the sclera of probable primary origin. Trans Am Ophthalmol Soc 13: 787, 1914.PubMedGoogle Scholar
  163. 163.
    Sarda RP, Mehrotra AS, Asnani K: Nodular episcleritis (a proved case of tubercular origin). Indian J Ocular Pathol 3: 24, 1969.Google Scholar
  164. 164.
    Swan KC: Some comtemporary concepts of scleral disease. Arch Ophthalmol 45: 630, 1951.Google Scholar
  165. 165.
    Finnoff WC: Tuberculosis in etiology of acute iritis. Am J Ophthalmol 14: 127, 1931.Google Scholar
  166. 166.
    Brini A, Quéré M, Achard M: Sclerite nodulaire nécrosante (presence de bacille de Koch). Bull Soc d’Ophtalmol France 7: 822, 1953.Google Scholar
  167. 167.
    Andreani DG: Tuberculoma of the sclera. Giornale Italiano di Oftalmologia 7: 506, 1954.Google Scholar
  168. 168.
    Walker C: Conglomerate tuberculosis of the iris with scleral perforation. Trans Ophthalmol Soc UK 86: 169, 1966.PubMedGoogle Scholar
  169. 169.
    Wilner G, Nassar SA, Siket A, Azar HA: Fluorescent staining for mycobacteria in sarcoid and tuberculous granulomas. Am J Clin Pathol 51: 584, 1969.PubMedGoogle Scholar
  170. 170.
    Evans JJ: Diffuse gummatous infiltration of scleral and episcleral tissues. Trans Ophthalmol Soc UK 25: 188, 1905.Google Scholar
  171. 171.
    Trantas M: Bourrelet périkératique syphilitique. Arch d’Ophtalmol 31: 320, 1911.Google Scholar
  172. 172.
    Bhaduri BN, Basu SK: Scleral gumma. Br J Ophthalmol 40: 504, 1956.Google Scholar
  173. 173.
    Yobs AR, Brown, L, Hunter EF: Fluorescent antibody technique in early syphilis. Arch Pathol 77: 220, 1964.PubMedGoogle Scholar
  174. 174.
    Tourville DR, Byrd LH, Kim DU, Zajd D, Lee I, Reichman LB, Baskin S: Treponemal antigen in immunopathogenesis of syphilitic glomerulonephritis. Am J Pathol 82: 479, 1976.PubMedGoogle Scholar
  175. 175.
    Bansal RC, Cohn H, Fani K, Lynfield YL: Nephrotic syndrome and granulomatous hepatitis. Arch Dermatol 114: 1228, 1978.PubMedGoogle Scholar
  176. 176.
    Beckett JH, Bigbee JW• Immunoperoxidase localization of Treponema pallidum. Arch Pathol 103: 135, 1979.Google Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • C. Stephen Foster
    • 1
  • Maite Sainz de la Maza
    • 2
  1. 1.Harvard Medical School, Immunology and Uveitis ServiceMassachusetts Eye and Ear InfirmaryBostonUSA
  2. 2.Central University of BarcelonaBarcelonaSpain

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