What is the role of imaging studies in the workup of scleritis?

Updated: Aug 29, 2019
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

See the list below:

  • Chest radiography or CT scanning - Tuberculosis, Granulomatosis with polyangiitis, allergic angiitis of Churg-Strauss syndrome, sarcoidosis, or atopy

  • Sinus films - Granulomatosis with polyangiitis

  • Sacroiliac radiography - Ankylosing spondylitis, reactive arthritis, psoriatic arthritis, or arthritis associated with inflammatory bowel disease

  • Limb joint radiography - Rheumatoid arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, or gout

  • Ultrasonography (A-scan and B-scan) - Posterior scleritis; most helpful test to aid in diagnosing posterior scleritis, which is characterized by flattening of the posterior aspect of the globe, thickening of the posterior sclera, and retrobulbar edema [6]

  • Orbital CT scanning - Posterior scleritis; a useful diagnostic tool to aid in detecting the following, which are important to differentiate posterior scleritis from orbital inflammatory diseases and orbital neoplasm: extraocular muscle or lacrimal gland enlargement, sinus tissue involvement, and posterior scleral thickening [7]

  • Orbital MRI - Posterior scleritis

    • MRI is used to differentiate localized inflammatory pseudotumor from posterior scleritis in patients with proptosis or choroidal tumors from posterior scleritis in patients with a subretinal mass.

    • Some orbital tumors, best visualized with MRI, can cause choroidal folds and retinal striae, which may also be signs of posterior scleritis.

  • Related clinical guideline summary from the American College of Radiology: ACR Appropriateness Criteria: Orbits, vision, and visual loss. [8]


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