Scleritis posterior

Unlike the more commonly encoimtered episcleritis, inflammation of the sclera is relatively rare, painfiil, and capable of extensive and permanent tissue and visual destruction. Scleritis is characterized by an immime-mediated vasculitis and inflammatory cell infiltration of the sclera and episclera. Scleritis usually occurs in the fiaurth to sixth decades of life but can be seen at any age. Peak incidence fi>r men is in the fiaurth decade, whereas there are two peaks for women the third and sixth decades. Diffuse scleritis shows a 1 1 distribution, whereas the other forms, particularly necrotizing and posterior scleritis, show a female predilection. Scleritis presents bilaterally about 50% of the time, and unilateral presentations usually... 

Posterior scleritis is more difficult to diagnose than anterior scleritis because it is harder to visualize and can present with few to no clinical signs.The underestimation of posterior scleritis is high, as demonstrated by studies in which 43% to 100% of enucleated eyes with histologic... 

Posterior scleritis is associated with anterior scleritis 60% of the time. Monitoring for change in visual acuity is important in scleritis because it may indicate new or progressive posterior involvement. Serial refractions can reveal scleritis-induced refractive error changes and scleral depression can identify and localize an area of posterior scleritis by eUciting intense pain when applied to the involved site. 

Figure 28-8 B-scan ultrasonogram of posterior scleritis demonstrating the edematous zone (arrow) produced by the posterior scleritis.

McCluskey PJ, Watson PG, Lightman S, et al. Posterior scleritis clinical features, systemic associations, and outcome in a large series of patients. Ophthalmology 1999 106 2380-2386. 

Woon WH, Stanford MR, Graham EM. Severe idiopathic posterior scleritis in children. Eye 1995 9(Pt 5) 570-574. 

Certain episcleritis, anterior (rarely posterior) uveitis, anterior (rarely posterior) scleritis... 

Thurairajan G, Hope-Ross MW, Situnayake RD, Murray PI. Polyarthropathy, orbital myositis and posterior scleritis an unusual adverse reaction to influenza vaccine. Br J Rheumatol 1997 36(l) 120-3. 

The sub-Tenon s space is located between the eyeball and the anterior surface of Tenons capsule, which separates the intra-orbital fat tissue from the posterior aspect of the eyeball. It is a potential space that can be enlarged by inflammatory fluid (as in posterior scleritis) or infiltrated by extraocular extension of intraocular tumors (as in uveal melanoma) (hintschich and rose 2005). 

Posterior scleritis is a special, locally confined type of idiopathic inflammation of the orbit, which presents clinically with slowly progressive, painful proptosis. Cross-sectional imaging shows diffuse thickening of the sclera and inflammation of adjacent tissue, with marked contrast uptake. As differential diagnoses, nodular scleritis does not show with contrast uptake, while uveal melanoma does take up contrast media, but usually delineates well (Mueller-Forell and Pitz 2004). 

Anterior uveitis Posterior uveitis Sympathetic ophthalmia Sclera Scleritis Episcleritis Retina... 

Clinical features of ARN must include (1) focal well-demarcated areas of retinal necrosis located in the retinal periphery, (2) rapid circumferential progression of necrosis, (3) evidence of occlusive vasculitis, and (4) moderate to severe anterior chamber and vitreal inflammation. Mild presentations may manifest low-grade anterior chamber inflammation with or without blurred vision, whereas severe cases may include episcleritis, scleritis, and pain on eye movement. Early clinical findings include anterior and posterior uveitis, keratic precipitates, and presence of vitreous cells. Within several days to weeks, the patient develops dramatic progressive retinal whitening in multifocal and confluent patches, vasculitis of both retinal arteries and veins, and possible optic nerve head... 

For anterior uveitis (or more uncommonly posterior or bilateral anterior uveitis), intensive topical therapies and/or systemic medications may be needed. In some cases, the drug will require discontinuation for the inflammation to resolve. Discontinuation is required for resolution of scleritis, even on full medical therapy. 

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