Abstract
Purpose: :
To evaluate clinical features, systemic associations, treatment and visual outcomes in Italian patients with episcleritis and scleritis.
Methods: :
Retrospective analysis of 110 consecutive patients with episcleritis and scleritis seen at the Uveitis Service of San Raffaele Scientific Institute, Milan, between 2006 and 2010. Each patient underwent complete clinical ophthalmological evaluation and slit-lamp high-resolution digital pictures were obtained.
Results: :
Of the 110 patients, 25 (23%) had episcleritis and 85 (77%) had scleritis. There was a predominance of women (64%) and unilateral disease (80%) in episcleritis and of women (74%) and unilateral disease (75%) in scleritis. Mean age at presentation was 42 in the episcleritis group and 52 in the scleritis group. Among those with episcleritis, 10 (40%) had focal episcleritis and 15 (60%) had diffuse episcleritis. Investigation revealed systemic disease association in 7 patients (28%) with episcleritis. Among those with scleritis, 28 (33%) had nodular anterior scleritis, 49 (58%) had diffuse anterior scleritis, 6 (7%) had necrotizing anterior scleritis and 2 (2%) had posterior scleritis. Thirteen patients (15%) had an associated infective disease: Herpes simplex (5%), Herpes zoster ophthalmicus (6%), Tuberculosis (2%), Syphilis (2%). Thirty patients (36%) had an associated autoimmune disease: Rheumatoid arthritis (10%), vasculitis (20%), HLA-B27 related diseases (2%), relapsing polychondritis (4%). Two (8%) patients with episcleritis lost visual acuity while 48 (56%) of the scleritis patients had a decrease in visual acuity. Only 16% of patients with episcleritis required more than topical corticosteroid treatment, while among the scleritis patients 33 (39%) required systemic NSAIDs, 21 (25%) oral corticosteroids, 18 (21%) immunosuppressive drugs and 13 (15%) antibiotics or antivirals.
Conclusions: :
An associated systemic disorder was found in 28% of Italian patients with episcleritis and in 51% of those with scleritis with a prevalence of autoimmune diseases over infectious diseases. Our study suggests that episcleritis is a mild ocular disorder which generally responds to topical medication. Conversely, scleritis is often associated with a decrease in visual function and requires oral medication.
Keywords: sclera • inflammation • autoimmune disease