title: Clinical features and presentation of infectious scleritis from herpes viruses: a report of 35 cases.
abstract: OBJECTIVE
  To describe clinical features and presentation of infectious scleritis resulting from herpes viruses.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Thirty-five patients out of 500 with scleritis.
  
  
  METHODS
  We reviewed the electronic health records of 500 patients with scleritis, 35 of whom were diagnosed with herpes virus infection, seen at 2 tertiary referral centers. We studied the clinical features and ocular complications of this subset of patient with scleritis.
  
  
  METHODS
  Correlation between classification, severity, and symptoms (i.e., pain) and diagnosis of herpetic-associated scleritis. Vision loss, presence of associated uveitis, keratitis, glaucoma, or systemic disease were documented over the follow-up period. Other outcome measures included epidemiologic data: age, gender, laterality, visual acuity, duration of symptoms, and underlying systemic or ocular diseases.
  
  
  RESULTS
  Of 500 patients with scleritis, 47 (9.4%) had an underlying infectious cause. Thirty-five (74.4%) of these were diagnosed with herpes virus infection, 5 (10.6%) with tuberculosis, and the remaining 7 (14.8%) with other infectious disease. Patients with herpes-associated scleritis were analyzed as a group and then compared with those with idiopathic scleritis. Most patients with herpetic scleritis presented with acute (85.7%) and unilateral (80%) scleral inflammation. Pain was moderate or severe in 68.6% of the patients. The most common type of scleritis was diffuse anterior in 80% (n = 28), followed by nodular anterior 11.4% (n = 4), and necrotizing in 8.6% (n = 3). Necrotizing anterior scleritis was more commonly seen in patients with herpetic scleritis versus patients with idiopathic disease (8.6% vs 1.2%; P<0.05). Unilaterality was also more common in herpetic scleritis (80%) than in idiopathic disease (56.7%; P<0.05). Vision loss was significantly greater in herpetic than idiopathic scleritis (34.3% vs 11.5%; P<0.001).
  
  
  CONCLUSIONS
  The association between scleritis and infectious disease may be higher than previously reported by other series. Herpes viruses account for 7% of all scleritis cases and its diagnosis may be challenging when there is not a classically diagnostic clinical picture. We present the observed clinical features of herpetic scleritis and describe the clinical differences at presentation between patients with idiopathic scleritis and those with herpes infection.
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts 021242, USA.
authors.forename: Luis Alonso
authors.initials: LA
authors.lastname: Gonzalez-Gonzalez
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molina-Prat
authors.forename: Priyanka
authors.initials: P
authors.lastname: Doctor
authors.forename: Joseph
authors.initials: J
authors.lastname: Tauber
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sainz de la Maza
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015828:Eye Infections, Viral / Q000145:classification / Q000175:diagnosis* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006561:Herpes Simplex / Q000145:classification / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015423:Scleritis / Q000145:classification / Q000175:diagnosis* / Q000821:virology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult