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Scleritis (Aetiology (Idiopathic
Most cases, Autoimmune
RA
Vasculitis
…
Scleritis
Aetiology
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Infection
Virus: VZV
Parasite: acanthamoeba
Bacteria: syphilis, TB
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Diagnosis
Examination
External eye examination
Deep red discolouration of sclera, may be
blue/black if scleral thinning, tender globe
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History
DH
Current meds, eye drops, allergies
FH
Autoummune disease,
ocular disease
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SH
Occupation, smoking, alcohol
PC/HPC
Very painful red eye,
no discharge, no visual change,
no photophobia
Investigations
Imaging
Slit lamp examination
Anterior segment angiography (if available) -
areas of ischemia can be identified
Bloods
FBC, CRP/ESR, U+E, LFTs
Immune bloods (RF, CCP, ANA, ANCA, ACE)
Infection bloods (syphilis)
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Clinical
presentation
Red eye
Deep red colouration of sclera
Diffuse or localised
Blue/black if scleral thinning
Eye pain
SEVERE, constant, deep boring pain
May radiate to forehead/temples
Wakes patient at night
Management
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Medical
NSAIDs
Indication: mild disease
E.g. PO diclofenac, naproxen
MOA: reduces inflammation and pain
SEs: gastric ulcers
Steroids
Indication: add on therapy/severe disease
E.g. IV methylprednisolone/PO prednisolone
MOA: reduced inflammation and symptoms
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