Abstract
Although significant advances have been made in the investigation of patients with scleritis, there is no substitute for careful history taking and a complete ocular examination. The type of scleritis (diffuse, nodular, or necrotizing), anatomical location (anterior, posterior, or both), and ocular complications will either reveal the diagnosis or guide the diagnostic approach to investigations.
Scleritis is idiopathic in up to 50% of patients, but may be caused by systemic inflammatory disease and develop as a manifestation of systemic or local infection or following ocular surgery. A wide range of potential investigations including full blood count, biochemical panels, serology, microbial culture and PCR, systemic imaging studies, and ocular imaging may be required to come to a specific diagnosis in individual patients. All investigations are based on the results of clinical assessment.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Akpek EK, Thorne JE, Qazi FA, et al. Evaluation of patients with scleritis for systemic disease. Ophthalmology. 2004;111:501–6.
Berchicci L, Miserocchi E, Di Nicola M, et al. Clinical features of patients with episcleritis and scleritis in an Italian tertiary care referral center. Eur J Ophthalmol. 2014;24:293–8.
Christian CL. Hepatitis B virus (HBV) and systemic vasculitis. Clin Exp Rheumatol. 1991;9:1–2.
Cordero-Coma M, Garcia-Moran A, Yilmaz T, et al. Adjunctive globe magnetic resonance imaging in the diagnosis of posterior scleritis. Can J Ophthalmol. 2011;46:329–32.
Cunningham MA, Alexander JK, Matoba AY, et al. Management and outcome of microbial anterior scleritis. Cornea. 2011;30:1020–3.
Doshi RR, Harocopos GJ, Schwab IR, et al. The spectrum of postoperative scleral necrosis. Surv Ophthalmol. 2013;58:620–33.
Fraunfelder FW, Winthrop K, Suhler E, et al. Postmarketing surveillance rates of uveitis and scleritis with bisphosphonates among a national veteran cohort. Retina. 2009;29:285–6.
Galor A, Thorne JE, Jabs DA. Rheumatic disease and scleritis. Ophthalmology. 2007;114:1232.
Gonzalez-Gonzalez LA, Molina-Prat N, Doctor P, et al. Clinical features and presentation of infectious scleritis from herpes viruses a report of 35 cases. Ophthalmology. 2012;119:1460–4.
Gungor IU, Ariturk N, Beden U, et al. Necrotizing scleritis due to varicella zoster infection: a case report. Ocul Immunol Inflamm. 2006;14:317–9.
Ho YF, Yeh LK, Tan HY, et al. Infectious scleritis in Taiwan-a 10-year review in a tertiary-care hospital. Cornea. 2014;33:838–43.
Hoang LT, Lim LL, Vaillant B, et al. Antineutrophil cytoplasmic antibody-associated active scleritis. Arch Ophthalmol. 2008;126:651–5.
Hodson K, Galor A, Karp C, et al. Epidemiology and visual outcomes in patients with infectious scleritis. Cornea. 2013;32:466–72.
Jabs DA, Mudun A, Dunn JP, et al. Episcleritis and scleritis: clinical features and treatment results. Am J Ophthalmol. 2000b;130:469–76.
Jennette JC, Falk RJ, Gasim AH. Pathogenesis of antineutrophil cytoplasmic autoantibody vasculitis. Curr Opin Nephrol Hypertens. 2011;20:263–70.
Kallenberg CG, Tadema H. Vasculitis and infections: contribution to the issue of autoimmunity reviews devoted to “autoimmunity and infection”. Autoimmun Rev. 2008;8:29–32.
Lin P, Bhullar SS, Tessler HH, et al. Immunologic markers as potential predictors of systemic autoimmune disease in patients with idiopathic scleritis. Am J Ophthalmol. 2008;145:463–71.
McCluskey PJ, Watson PG, Lightman S, et al. Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients. Ophthalmology. 1999;106:2380–6.
Nityanand S, Holm G, Lefvert AK. Immune complex mediated vasculitis in hepatitis B and C infections and the effect of antiviral therapy. Clin Immunol Immunopathol. 1997;82:250–7.
Okhravi N, Odufuwa B, McCluskey P, et al. Scleritis. Surv Ophthalmol. 2005;50:351–63.
Pradhan ZS, Jacob P. Infectious scleritis: clinical spectrum and management outcomes in India. Indian J Ophthalmol. 2013;61:590–3.
Ramesh S, Ramakrishnan R, Bharathi MJ, et al. Prevalence of bacterial pathogens causing ocular infections in South India. Indian J Pathol Microbiol. 2010;53:281–6.
Smith JR, Mackensen F, Rosenbaum JT. Therapy Insight: Scleritis and its relationship to systemic autoimmune disease. Nat Clin Pract Rheumatol. 2007;3:219–26.
Wakefield D, Di Girolamo N, Thurau S, et al. Scleritis: Immunopathogenesis and molecular basis for therapy. Prog Retin Eye Res. 2013a;35:44–62.
Wakefield D, Di Girolamo N, Thurau S, et al. Scleritis: challenges in immunopathogenesis and treatment. Discov Med. 2013b;16:153–7.
Watkins AS, Kempen JH, Choi D, et al. Ocular disease in patients with ANCA-positive vasculitis. J Ocul Biol Dis Infor. 2010;3:12–9.
Watson P, Romano A. The impact of new methods of investigation and treatment on the understanding of the pathology of scleral inflammation. Eye (Lond). 2014;28:915–30.
Compliance with Ethical Requirements
Conflict of interest – Nil
Informed consent – NAD
Human/animal studies – NAD
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Zagora, S.L., McCluskey, P.J. (2017). Diagnostic Approach to Scleritis. In: Pavesio, C. (eds) Scleritis. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-49915-4_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-49915-4_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-49913-0
Online ISBN: 978-3-319-49915-4
eBook Packages: MedicineMedicine (R0)