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Chapter 029. Disorders of the Eye (Part 8)

Episcleritis This is an inflammation of the episclera, a thin layer of connective tissue between the conjunctiva and sclera. Episcleritis resembles conjunctivitis but is a more localized process and discharge is absent. Most cases of episcleritis are idiopathic, but some occur in the setting of an autoimmune disease. Scleritis refers to a deeper, more severe inflammatory process, frequently associated with a connective tissue disease such as rheumatoid arthritis, lupus erythematosus, polyarteritis nodosa, Wegener's granulomatosis, or relapsing polychondritis. The inflammation and thickening of the sclera can be diffuse or nodular. In anterior forms of scleritis, the globe assumes a violet. | Chapter 029. Disorders of the Eye Part 8 Episcleritis This is an inflammation of the episclera a thin layer of connective tissue between the conjunctiva and sclera. Episcleritis resembles conjunctivitis but is a more localized process and discharge is absent. Most cases of episcleritis are idiopathic but some occur in the setting of an autoimmune disease. Scleritis refers to a deeper more severe inflammatory process frequently associated with a connective tissue disease such as rheumatoid arthritis lupus erythematosus polyarteritis nodosa Wegener s granulomatosis or relapsing polychondritis. The inflammation and thickening of the sclera can be diffuse or nodular. In anterior forms of scleritis the globe assumes a violet hue and the patient complains of severe ocular tenderness and pain. With posterior scleritis the pain and redness may be less marked but there is often proptosis choroidal effusion reduced motility and visual loss. Episcleritis and scleritis should be treated with NSAIDs. If these agents fail topical or even systemic glucocorticoid therapy may be necessary especially if an underlying autoimmune process is active. Uveitis Involving the anterior structures of the eye this is also called iritis or iridocyclitis. The diagnosis requires slit-lamp examination to identify inflammatory cells floating in the aqueous humor or deposited upon the corneal endothelium keratic precipitates . Anterior uveitis develops in sarcoidosis ankylosing spondylitis juvenile rheumatoid arthritis inflammatory bowel disease psoriasis Reiter s syndrome and Behçet s disease. It is also associated with herpes infections syphilis Lyme disease onchocerciasis tuberculosis and leprosy. Although anterior uveitis can occur in conjunction with many diseases no cause is found to explain the majority of cases. For this reason laboratory evaluation is usually reserved for patients with recurrent or severe anterior uveitis. Treatment is aimed at reducing inflammation and scarring by .