SEVERITY OF SCLERITIS AND EPISCLERITIS

Purpose: inflammation of the wall of the eyeball may extend to adjacen t ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. This study was undertaken to e valuate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis. Methods: Ocular com plications and specific disease association were evaluated in 266 pati ents (358 eyes) with different types of scleritis (diffuse, nodular, n ecrotizing, 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%, periphera l ulcerative keratitis developed in 14%, glaucoma occurred in 13%, cat aract formed in 17%, fundus abnormalities appeared in 6%, and specific disease association was uncovered in 57%. These findings were most co mmonly associated with necrotizing scleritis. In patients with episcle ritis, decreased vision occurred in 2%, anterior uveitis was present i n 11%, glaucoma developed in 4%, cataract formed in 2%, and specific d isease association was uncovered in 32%. These findings were similar i n simple and nodular episcleritis. Conclusions: In a patient with scle ritis, examination of visual acuity, anterior uvea, cornea, lens, intr aocular pressure, and fundus must be performed in every follow-up visi t, and a meticulous approach for detection of a specific associated di sease must be undertaken since the first visit. Scleritis is more seve re than episcleritis, and necrotizing scleritis is the most severe typ e of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information.