Eyeworld

EW MEETING REPORTER 115 tremendous resource," Dr. Rubenstein said. Confocal mi- croscopy also can be used as a substitute to pachymetry to deter- mine corneal thickness, he said. Dr. Chang rounded out the ses- sion by touting the benefits of wave- front aberrometry in evaluating unhappy multifocal IOL patients. "If you're going to implant a multifocal, you have to have a beautiful cornea," he said. Editors' note: Drs. Foster and Rubenstein have no financial interests related to their talks. Dr. Stulting has a financial interest with Optovue (Fremont, Calif.). Cornea and external disease: Spotting systemic predictions of death There are few true ocular emergen- cies ophthalmologists face, but necrotizing scleritis is one of them, concluded a distinguished panel in the Cornea & External Disease: Prac- tical Topics & Interactive Panel Dis- cussion session. When a patient comes into your practice with this advanced stage of scleritis, you must assume it's the presenting sign of a life-threatening illness. "Necrotizing scleritis is an ab- solute ophthalmic emergency be- cause the risk of perforation of that eye is very severe," said Edward J. Holland, M.D., co-chair of Winter Update, and professor of ophthal- mology, University of Cincinnati. "The chance that the patient has a severe systemic disease that will cause death is very significant." Scleritis and episcleritis are two eye diseases that are not uncommon and often difficult to differentiate, said Dr. de Luise. Scleritis is a painful, progressive, and potentially recurrent inflamma- tion of deep episclera and sclera. Episcleritis is less severe and is a self- limited inflammatory disease of su- and 50% are a sign of an immune- medicated systemic disease. With episcleritis, the risk drops, but it's still possible that episcleritis is a sign of something more sinister going on in the body. "In about a quarter of the cases where there is a systemic disease, scleritis can be the presenting sign," said Dr. de Luise. Because of this, Dr. de Luise rec- ommended a host of lab tests on these patients, looking for syphilis, tuberculosis, and Lyme disease, to name a few. He also strongly recom- mended enlisting the help of a rheumatologist, calling it "crucial." For treatment, Dr. de Luise finds topical steroids to be largely ineffec- tive for the management of scleritis. "I do not use topical steroids," he said. "I do not see a value here. This is arguably a systemic disease so you need systemic treatment." Dr. de Luise goes straight for oral corticosteroids, with his first line strategy being 60-80 mg p.o.q. of prednisone. Editors' note: Dr. de Luise has no finan- cial interests for this topic. Dr. Holland has financial interests with Abbott Medical Optics (Santa Ana, Calif.), Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Bausch & Lomb (Rochester, N.Y.), Inspire Pharmaceuticals (Raleigh, N.C.), OCuSOFT (Richmond, Texas), QLT (Menlo Park, Calif.), Senju Pharmaceu- ticals (Osaka, Japan), and WaveTec Vi- sion Systems Inc. (Aliso Viejo, Calif.). March 2011 perficial episclera. "If there is pain, think scleri- tis. If there is itching, think epis- cleritis," said Dr. de Luise on how to tell the difference between these similarly acting ailments. Early and accurate diagnosis is essential, as is systemic workup, because both of these diseases can be associated with other serious ill- nesses such as rheumatoid arthri- tis, Wegener's granulomatosis, immune-complex vasculitis, and gout. Dr. de Luise estimated that 50% of scleritis cases are idiopathic continued on page 116

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