Elsevier

Ophthalmology

Volume 119, Issue 1, January 2012, Pages 43-50
Ophthalmology

Original article
Clinical Characteristics of a Large Cohort of Patients with Scleritis and Episcleritis

https://doi.org/10.1016/j.ophtha.2011.07.013Get rights and content

Objective

To evaluate the demographic characteristics, clinical features, ocular complications, and disease associations of patients with scleritis and episcleritis; as well as to delineate the risk factors for decreased vision in patients with scleritis.

Design

Retrospective case series.

Participants

Five hundred patients with scleritis and 85 patients with episcleritis.

Methods

The electronic health records of 500 patients with scleritis and 85 patients with episcleritis seen at 2 tertiary referral centers were reviewed and their clinical features were studied.

Main Outcome Measures

Clinical features (pain, scleral inflammation), ocular complications (decrease in vision, anterior uveitis, peripheral ulcerative keratitis, ocular hypertension), and disease associations.

Results

In a series of 585 patients, 500 patients had scleritis (85.5%) and 85 patients had episcleritis (14.2%). Ocular complications were more frequent overall in patients with scleritis versus in those with episcleritis (45.0% vs. 19.0%), including decrease in vision (15.8% vs. 2.3%), anterior uveitis (26.4% vs. 16.5%), peripheral ulcerative keratitis (7.4% vs. 0%), and ocular hypertension (14.2% vs. 3.5%; P<0.0001 for each). Disease association was observed in 35.8% of patients with scleritis versus 27.1% of episcleritis patients, including connective tissue or vasculitic diseases in 24.8% versus 15.3%, respectively. Scleritis preceded systemic disease diagnosis in 38.7% of patients. Ocular complications (90.0%) and disease association (80.0%) occurred most often in patients with necrotizing scleritis (P<0.0001 for each). Risk factors for decrease in vision in patients with scleritis included necrotizing scleritis (odds ratio [OR], 6.63; P<0.001), posterior scleritis (OR, 2.33; P = 0.042), degree of scleral inflammation of more than 2+ (range, 0–4+; OR, 3.60; P<0.001), anterior uveitis (OR, 1.78; P = 0.033), ocular hypertension (OR, 3.19; P<0.001), and associated disease (OR, 2.66; P<0.001), mainly infectious (OR, 4.44; P<0.001).

Conclusions

Scleritis is associated more often with ocular complications than episcleritis, and necrotizing scleritis is the type of scleritis most often associated with ocular complications and disease association. Risk factors for decrease in vision in patients with scleritis include necrotizing scleritis, posterior scleritis, scleral inflammation of more than 2+, anterior uveitis, ocular hypertension, and associated infectious disease.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients

The electronic health records were reviewed of all patients with scleritis or episcleritis seen at MERSI, Cambridge, Massachusetts, during the 5-year period from April 2005 through April 2010, and at the Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain, during the 3-year period from April 2007 through April 2010. The institutional review board of each clinical center reviewed the study protocol before initiating the study (approved for MERSI and not required

Demographic and Clinical Characteristics

Of 4909 new patient referrals to the MERSI, Cambridge, Massachusetts, during the 5-year period from April 2005 through April 2010, 8.7% of the patients had scleritis and 1.4% had episcleritis. A total of 585 patients (825 eyes) constituted the study population. Five hundred of the patients (706 eyes) had scleritis (85.5%) and 85 patients (119 eyes) had episcleritis (14.2%; Fig 1). Most of the patients with scleritis had anterior scleritis (469 patients; 93.8%), including 375 (75.0%) with

Discussion

A total of 500 patients with scleritis and 85 patients with episcleritis were reviewed in 2 tertiary referral centers. The results inevitably are biased to higher numbers of patients with scleritis compared with patients with episcleritis. A significant factor in this is underreporting of episcleral disease. Many patients with previously diagnosed episcleritis understand that recurrent episodes are unlikely to cause damage to the eye, so either they do not treat the condition or they

References (15)

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Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Manuscript no. 2011-567.

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