Severity of scleritis and episcleritis.
OBJECTIVE
Inflammation of the wall of the eyeball may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. This study was undertaken to evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis.


METHODS
Ocular complications and specific disease association were evaluated in 266 patients (358 eyes) with different types of scleritis (diffuse, nodular, necrotizing, scleromalacia perforans, and posterior) and episcleritis (simple and nodular).


RESULTS
In patients with scleritis, decrease in vision occurred in 37%, anterior uveitis was present in 42%, peripheral ulcerative keratitis developed in 14%, glaucoma occurred in 13%, cataract formed in 17%, fundus abnormalities appeared in 6%, and specific disease association was uncovered in 57%. These findings were most commonly associated with necrotizing scleritis. In patients with episcleritis, decreased vision occurred in 2%, anterior uveitis was present in 11%, glaucoma developed in 4%, cataract formed in 2%, and specific disease association was uncovered in 32%. These findings were similar in simple and nodular episcleritis.


CONCLUSIONS
In a patient with scleritis, examination of visual acuity, anterior uvea, cornea, lens, intraocular pressure, and fundus must be performed in every follow-up visit, and a meticulous approach for detection of a specific associated disease must be undertaken since the first visit. Scleritis is more severe than episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information.
Sainz de la Maza
M
M
Ocular Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
Jabbur
N S
NS
Foster
C S
CS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003320:Corneal Ulcer / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015423:Scleritis / Q000145:classification / Q000150:complications*; D014606:Uveitis, Anterior / Q000209:etiology