April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Clinical Features And Visual Outcomes Of Italian Patients With Episcleritis And Scleritis In A Tertiary Care Referral Center
Author Affiliations & Notes
  • Giulio Modorati
    Dept of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
  • Luigi Berchicci
    Dept of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
  • Elisabetta Miserocchi
    Dept of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
  • Annalisa Colucci
    Dept of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
  • Maura Di Nicola
    Dept of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
  • Francesco Bandello
    Dept of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
  • Footnotes
    Commercial Relationships  Giulio Modorati, None; Luigi Berchicci, None; Elisabetta Miserocchi, None; Annalisa Colucci, None; Maura Di Nicola, None; Francesco Bandello, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 4279. doi:https://doi.org/
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      Giulio Modorati, Luigi Berchicci, Elisabetta Miserocchi, Annalisa Colucci, Maura Di Nicola, Francesco Bandello; Clinical Features And Visual Outcomes Of Italian Patients With Episcleritis And Scleritis In A Tertiary Care Referral Center. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4279. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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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 
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