Eyeworld

FEB 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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February 2012 Anterior continued from page 52 Scleritis Half of all patients with scleritis have an underlying systemic disease, most often rheumatoid arthritis, which is why it's imperative to make a correct diagnosis and initiate a full evaluation. Scleritis can be easily misdiagnosed as episcleritis, its less severe counterpart. "Scleritis is an [extremely] painful condition," said Dr. Sheppard. "There's a deep, boring, relentless pain." With scleritis almost anything is possible including visual loss, corneal edema, and anterior seg- ment inflammation. Episcleritis, however, is localized with less pain and more irritation. "The patient with episcleritis is typically young and healthy, male or female, and oftentimes has an al- lergy history," Dr. de Luise said . "Episcleritis does not cause visual change. The patients don't come in complaining of blurred vision, they come in complaining of irritation, redness, and itching." One trick Dr. de Luise uses for differentiating between the two is using a drop of phenylephrine in the eye. In a patient with episcleritis, the eye will blanch almost com- pletely. In those with scleritis, how- ever, the deeper blood vessels will not whiten and the patient will still have redness. He also likes to take patients to the front of the office where there is natural light and look for a purple-red discoloration of the eye, a classic sign of scleritis. Treatment options for episcleri- tis are much more simple than scle- ritis and include cold packs, artificial tears, anti-histamine eye drops, or topical steroids. The patients should be told the condition will probably come back off and on over the next 2 or 3 years, but they will eventually grow out of it. For scleritis, however, eye drops are not going to solve the problem because usually the issue is with the whole body, not just the eye. Treatment options include TNF- inhibitors and steroids such as pred- nisone, but you don't want to keep the patient on steroids for too long. Dr. de Luise likes to use an H2 recep- tor antagonist to protect the pa- tient's stomach from developing an ulcer due to the prednisone. You also want to get the patient to the rheumatologist and immediately begin testing for possible systemic causes. "You should always order FTA- ABS and Lyme tests," Dr. de Luise. said "Syphilis and Lyme, which are the great mimickers, can have scleri- Toll free 1-888-519-5375 www.oculususa.com sales@oculususa.com www.pentacam.com OCULUS Pentacam® /Pentacam® The indispensable tool for anterior segment analysis • Anterior and posterior corneal topography • 3D Cataract analysis • Evaluation of corneal optical quality for premium IOLs • Holladay Report for post-refractive IOL calculations • NEW Iris camera and automatic HWTW measurement • NEW Belin/Ambrosio 3, improved for Hyperopic eyes • LASIK Screening Join us at the ASCRS in Chicago - Booth #1609 HR tis associated with them. Interest- ingly, rosacea can cause scleritis, but not commonly." Dr. de Luise also recommends ordering a rheumatoid factor test for rheumatoid arthritis, ANCA test for Wegener's, a tuberculosis skin test, and even an MRI or CT scan because occasionally what looks like scleritis is actually an orbital tumor. "If patients present with scleritis in their 50s and 60s, chances are if they don't already have a systemic magnification, the disease will be much more benign or it may not be an autoimmune disease. It may be a systemic infection," said Dr. Sheppard. "If a 27-year-old woman presents in your office with a necro- tizing form of scleritis, then you know this patient is headed for a long battle against autoimmune dis- ease. Immediate intervention with an appropriate systemic agent can make all the differenence in the long-term prognosis." EW Editors' note: Drs. de Luise and Sheppard have no financial interests related to this article. Contact information de Luise: eyemusic73@gmail.com Sheppard: docshep@hotmail.com EW CORNEA 55 facebook.com/OCULUSusa

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