Scleritis, Episcleritis

Scleritis, episcleritis

Inflammation of the sclera and episclera in rheumatism, tuberculosis, less commonly syphilis, acute infectious diseases. Inflammation usually spreads to the sclera from the vascular tract, primarily from the ciliary body.

Symptoms The anterior scleritis is usually bilateral. Onset is slow or subacute. Between the limbus and the equator of the eye, limited swelling and hyperemia with a bluish tint appear. On palpation, sharp pain is noted. In severe cases, foci of inflammation cover the entire pericorneal region (ring-shaped scleritis). The process may spread to the cornea (sclerosing keratitis) and complications such as iridocyclitis, vitreous opacities, and secondary glaucoma.

The process takes a long time - many months, sometimes years. Upon completion, atrophic areas of the sclera of slate color remain, which, under the influence of intraocular pressure, can stretch and protrude (ectasia and staphyloma of the sclera). A type of anterior scleritis is gelatinous sclerokeratitis with infiltration in the limbus of a red-brown color and gelatinous appearance and involvement of the cornea in the process.

With posterior scleritis, pain when moving the eye, limited mobility, swelling of the eyelids and conjunctiva, and mild exophthalmos are noted. Episcleritis is characterized by the appearance at the limbus in new places of hyperemic round-shaped nodules (nodular episcleritis) or flat hyperemic lesions that appear on one or the other eye (migratory episcleritis). Scleritis differs from episcleritis in the greater severity of the process and the involvement of the vascular tract in it.

Nodular episcleritis resembles phlyctenas and differs from them in the duration of the course and the absence of vessels suitable for the nodule.

Treatment of the underlying disease that caused scleritis or episcleritis. Elimination of irritants that can cause an allergic reaction (foci of chronic infection, eating disorders, etc.). General and local use of desensitizing drugs - cortisone, diphenhydramine, calcium chloride, etc. For the rheumatic nature of scleritis, salicylates, butadione, rheopirin are indicated, for infectious scleritis - antibiotics and sulfonamides.

For tuberculous-allergic scleritis, desensitizing and specific treatment is recommended (PASK, ftivazide, saluzide, metazide, etc.). Local treatment - heat, physiotherapeutic procedures, mydriatic agents (with normal intraocular pressure).

The prognosis for episcleritis is favorable. In patients with scleritis, the prognosis depends on the degree of involvement of the cornea and inner membranes of the eye in the process, as well as on the timeliness of treatment.