NEW CLINICAL AND EPIDEMIOLOGIC ASPECTS OF EPISCLERITIS AND SCLERITIS

Numerous systemic diseases can cause scleritis or episcleritis. Freque ntly, symptoms and complications compromising vision can only be manag ed with systemic immunosuppressants. There are no clear guidelines on the indications for systemic immunosuppressants in patients with episc leritis and scleritis. Patients and methods. The aim of the present re trospective study was to investigate how many patients with episclerit is or scleritis have an associated systemic disease and at what stage it is diagnosed. Secondly, the proportion of patients who present with episcleritis or scleritis in the first instance and then change into the other category during the course of the disease was analyzed. Fina lly, we checked wh ether the presence of an associated systemic diseas e indicates the necessity to treat the patient with nonsteroidal syste mic immunosuppressive drugs. Results. Sixty-eight patients with inflam matory scleral diseases were treated at the University Eye Clinic betw een 1991 and 1995. In 13 patients an associated systemic disease was d iagnosed before the appearance of ocular symptoms, and in 8 patients s uch an illness was diagnosed at a later stage. In 2 cases (3%) the ocu lar disease category changed during the course of the disease. Neither in the episcleritis nor in the scleritis population was a statistical ly significant correlation established between the diagnosis of an ass ociated systemic disease and the necessity to treat the patient with n onsteroidal systemic immunosuppressive drugs. Conclusion. The small nu mber of patients who changed the ocular disease category may indicate that episcleritis and scleritis are two independent entities, which mi ght even be caused by different mechanisms. The indications for the ma nagement of episcleritis and scleritis with immunosuppressive drugs sh ould not only depend on the diagnosis of an associated systemic diseas e, but also and mainly on the severity of the ocular manifestation.