The Rheumatologist
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
  • Technology
    • Electronic Health Records
    • Apps
    • Information Technology
  • Resources
    • Issue Archives
    • Events
    • Multimedia
      • Audio
      • Video
    • From the College
    • American College of Rheumatology
    • Rheumatology Research Foundation
    • Arthritis & Rheumatology
    • Arthritis Care & Research
    • Treatment Guidelines
    • Research Reviews
    • Annual Meeting
      • Abstracts
      • Meeting Reports
    • Rheumatology Image Bank
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Scleritis Often Diagnosed by Ophthalmologists, But Rheumatologists Help Determine Systemic Causes

Scleritis Often Diagnosed by Ophthalmologists, But Rheumatologists Help Determine Systemic Causes

March 15, 2016 • By Vanessa Caceres

  • Tweet
  • Email
Print-Friendly Version / Save PDF
ARZTSAMUI/shutterstock.com

ARZTSAMUI/shutterstock.com

Ophthalmologists may be more likely to initially diagnose and treat scleritis, an inflammation of the scleral tissues of the eye. However, rheumatologists need to remain aware of the condition as well: It’s commonly associated with rheumatic disorders, such as rheumatoid arthritis (RA).

You Might Also Like
  • 7 Things Ophthalmologists Want Rheumatologists to Know
  • 2013 ACR/ARHP Annual Meeting: Inflammatory Eye Disease Management Can Benefit from Collaboration between Rheumatologists and Ophthalmologists
  • Research Into Causes of Systemic Vasculitis May Lead to Targeted Treatments Say Rheumatologists at the 2013 ACR/ARHP Annual Meeting
Explore this issue
March 2016
Also by this Author
  • How Rheumatologists Can Boost Patient Understanding of Educational Materials

Scleritis can present in the eye anteriorly or posteriorly. “Anterior scleritis can be diffuse, nodular, necrotizing with inflammation and necrotizing without inflammation,” says ophthalmologist Gaston O. Lacayo, III, MD, Center for Excellence in Eyecare, Miami. “The most common clinical forms are diffuse scleritis and nodular scleritis.”

Although necrotizing scleritis is less common, it’s more ominous and frequently associated with systemic autoimmune disorders, Dr. Lacayo says.

There is also posterior scleritis, which is characterized by the flattening of the choroid and sclera and retrobulbar edema, Dr. Lacayo says. Posterior scleritis can negatively affect the vision, and it can be difficult to diagnose because it is not always seen during a slitlamp examination, says Esen K. Akpek, MD, The Bendann Family Professor of Ophthalmology and Rheumatology, and associate director, Johns Hopkins Jerome L. Greene Sjögren’s Syndrome Center, The Wilmer Eye Institute at Johns Hopkins, Baltimore.

Scleritis Symptoms

The symptoms of scleritis coincide with a number of eye problems. “It’s mostly redness and eye pain,” Dr. Akpek says. “The patients might get blurred vision if the posterior sclera is involved. Sometimes the inflammation spills over to the anterior chamber, causing uveitis. That also can cause blurred vision,” Dr. Akpek says.

If not treated properly, scleritis leads to blindness in severe cases.

Eye pain is sometimes so bad at night, it can cause trouble sleeping, says rheumatologist Elyse Rubenstein, MD, Providence Saint John’s Health Center, Santa Monica, Calif. Headaches and photophobia are other possible symptoms of scleritis.

These same symptoms can accompany conjunctivitis, iritis, keratitis, uveitis, herpes zoster and corneal melt, among other ocular disorders, Dr. Rubenstein says.

Treating physicians must also make the distinction between scleritis and the more benign episcleritis. “The redness in episcleritis is a brighter red, and in scleritis, it’s more bluish red,” Dr. Akpek says. “Also, with the exam, there’s scleral edema and deep episcleral vascular engorgement with scleritis.”

Slitlamp examination detects the intraocular inflammation in scleritis and assesses severity. CT scan, MRI and ultrasound are sometimes necessary to help determine the extent of involvement and make a differential diagnosis, says rheumatologist Anca Askanase, MD, clinical director and founder of the new Lupus Center at Columbia University Medical Center, New York.

Pages: 1 2 3 Single Page

Filed Under: Conditions, Systemic Inflammatory Syndromes Tagged With: Cause, Diagnosis, eye, inflammation, ophthamologist, patient care, Rheumatic Disease, rheumatologist, scleritis, symptomIssue: March 2016

You Might Also Like:
  • 7 Things Ophthalmologists Want Rheumatologists to Know
  • 2013 ACR/ARHP Annual Meeting: Inflammatory Eye Disease Management Can Benefit from Collaboration between Rheumatologists and Ophthalmologists
  • Research Into Causes of Systemic Vasculitis May Lead to Targeted Treatments Say Rheumatologists at the 2013 ACR/ARHP Annual Meeting
  • Causes of Alopecia Can Vary Among Patients with Systemic Disease Say Experts at the 2013 ACR/ARHP Annual Meeting

Comments

  1. Nilzio A. da Silva says

    March 23, 2016 at 4:27 pm

    Most patients with scleritis sent by ophtalmologists are of unknown ethiology.

    Reply
  2. Dr Prasanta Padhan says

    March 25, 2016 at 12:25 pm

    Nice article, just few comments for the rheumatologist in the developing world:
    1. Infections such as Leprosy, tuberculosis should be considered as aetiology.
    2. Again treatment with adalimumab poses a significant theat for tuberculosis reactivation.
    3. Response to mycophenolate is excellent for those who don’t do well on methotrexate.

    Reply
  3. David Muxlow says

    October 9, 2017 at 9:34 pm

    My wife saw 3 ophthalmologists and her primary care physician over 9 months. During that time she had severe schleritis and was given steroids drops and each time they were reduded the inflammation flared up. She was routinely told the condition was pink eye. She finally got an appointment to see a rheumatologist two weeks ago. She was just diagnosed with RA and missed 9 months of opportunity for correct treatment because no one even suggested maybe she should see a rheumatologist. Hopefully more doctors in the future will consider RA when RA symptoms are present and they can’t figure out what’s causing them.

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

ACR/ARP Annual Meeting

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Annual Meeting site »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2019 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.