Which clinical history findings are characteristic of scleritis?

Answer

Scleritis is subacute; with a more gradual onset than in episcleritis.^[26] Scleritis generally persists from months to years, whereas episcleritis usually resolves within weeks. Both eyes are affected in slightly more than one half of cases.

Severe, constant, deep, boring, or pulsating pain is noted. Pain worsens with movement of the eye and is worse at night and may awaken the patient. Pain may be referred to the eyebrow, temple, or jaw. Occasionally, the configuration of the pain pattern corresponds to the course of the trigeminal nerve.

Erythema of the eye is a defining symptom with anterior scleritis. Other signs and symptoms include lacrimation and photophobia. Discharge is ordinarily not part of the clinical picture of scleritis. Less common manifestations include nausea/vomiting and headache

Prior history may include underlying systemic disease^[12], trauma, ocular surgery, glaucoma, exposure to irritants/chemicals, previous use of eye drops and medications. Uncommonly, patients may report similar previous episodes.

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Lagina A, Ramphul K. Scleritis. 2020 Jan. [Medline]. [Full Text].
Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. 2006 Apr. 119(4):302-6. [Medline]. [Full Text].
Welch JF, Dickie AK. Red Alert: diagnosis and management of the acute red eye. J R Nav Med Serv. 2014. 100 (1):42-6. [Medline].
Ashok D, Ayliffe WH, Kiely PD. Necrotizing scleritis associated with rheumatoid arthritis: long-term remission with high-dose infliximab therapy. Rheumatology (Oxford). 2005 Jul. 44(7):950-1. [Medline].
Sainz de la Maza M, Jabbur NS, Foster CS. Severity of scleritis and episcleritis. Ophthalmology. 1994 Feb. 101(2):389-96. [Medline].
Legmann A, Foster CS. Noninfectious necrotizing scleritis. Int Ophthalmol Clin. 1996 Winter. 36(1):73-80. [Medline].
Gonzales JA, Haemel A, Gross AJ, Acharya NR. Management of Uveitis and Scleritis in Necrobiotic Xanthogranuloma. J Ocul Pharmacol Ther. 2017 May. 33 (4):325-333. [Medline].
Rossiter-Thornton M, Rossiter-Thornton L, Ghabrial R, Azar DA. Posterior scleritis mimicking orbital cellulitis. Med J Aust. 2010 Sep 6. 193(5):305-6. [Medline].
González-López JJ, Lavric A, Dutta Majumder P, Bansal N, Biswas J, Pavesio C, et al. Bilateral Posterior Scleritis: Analysis of 18 Cases from a Large Cohort of Posterior Scleritis. Ocul Immunol Inflamm. 2016. 24 (1):16-23. [Medline].
Vergouwen DPC, Rothova A, Berge JCT, Verdijk RM, van Laar JAM, Vingerling JR, et al. Current insights in the pathogenesis of scleritis. Exp Eye Res. 2020 Aug. 197:108078. [Medline].
Fong LP, Sainz de la Maza M, Rice BA, Kupferman AE, Foster CS. Immunopathology of scleritis. Ophthalmology. 1991 Apr. 98(4):472-9. [Medline].
Smith JR, Mackensen F, Rosenbaum JT. Therapy insight: scleritis and its relationship to systemic autoimmune disease. Nat Clin Pract Rheumatol. 2007 Apr. 3(4):219-26. [Medline]. [Full Text].
Wakefield D, Di Girolamo N, Thurau S, Wildner G, McCluskey P. Scleritis: challenges in immunopathogenesis and treatment. Discov Med. 2013 Oct. 16(88):153-7. [Medline].
Cazabon S, Over K, Butcher J. The successful use of infliximab in resistant relapsing polychondritis and associated scleritis. Eye. 2005 Feb. 19(2):222-4. [Medline].
Nevares A, Raut R, Libman B, Hajj-Ali R. Noninfectious Autoimmune Scleritis: Recognition, Systemic Associations, and Therapy. Curr Rheumatol Rep. 2020 Mar 26. 22 (4):11. [Medline].
Lee SB, Kim KS, Lee WK, Kim YJ, Kang MW. Ocular syphilis characterised by severe scleritis in a patient infected with HIV. Lancet Infect Dis. 2013 Nov. 13(11):994. [Medline].
Hilkert SM, Koreishi AF, Pyatetsky D. Poststreptococcal syndrome presenting as posterior scleritis in a child. J AAPOS. 2017 Apr. 21 (2):163-165. [Medline].
Leung S, Ashar BH, Miller RG. Bisphosphonate-associated scleritis: a case report and review. South Med J. 2005 Jul. 98(7):733-5. [Medline].
Ryu SJ, Kang MH, Seong M, Cho H, Shin YU. Anterior scleritis following intravitreal injections in a patient with rheumatoid arthritis: A case report. Medicine (Baltimore). 2017 Nov. 96 (47):e8925. [Medline]. [Full Text].
Honik G, Wong IG, Gritz DC. Incidence and prevalence of episcleritis and scleritis in Northern California. Cornea. 2013 Dec. 32 (12):1562-6. [Medline]. [Full Text].
Xu TT, Reynolds MM, Hodge DO, Smith WM. Epidemiology and Clinical Characteristics of Episcleritis and Scleritis in Olmsted County, Minnesota. Am J Ophthalmol. 2020 Sep. 217:317-324. [Medline].
Hung J, Tsai JH. Scleritis. EyeWiki. Available at http://eyewiki.aao.org/Scleritis. December 1, 2020; Accessed: February 8, 2020.
Levison AL, Lowder CY, Baynes KM, Kaiser PK, Srivastava SK. Anterior segment spectral domain optical coherence tomography imaging of patients with anterior scleritis. Int Ophthalmol. 2016 Aug. 36 (4):499-508. [Medline].
Thill M, Richard G. Giant pigment epithelial tear and retinal detachment in a patient with scleritis. Retina. 2005 Jul-Aug. 25(5):667-8. [Medline].
Dean WH, Turner SA, McNaught AI. Secondary glaucoma due to chronic scleritis: trabeculectomy in scleromalacia: a case report. Eye (Lond). 2014 Jan. 28 (1):104-6. [Medline].
Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. 1976 Mar. 60(3):163-91. [Medline].
Gonzalez-Gonzalez LA, Molina-Prat N, Doctor P, Tauber J, Sainz de la Maza M, Foster CS. Clinical Features and Presentation of Posterior Scleritis: A Report of 31 Cases. Ocul Immunol Inflamm. 2013 Oct 16. [Medline].
Murthy SI, Sabhapandit S, Balamurugan S, Subramaniam P, Sainz-de-la-Maza M, Agarwal M, et al. Scleritis: Differentiating infectious from non-infectious entities. Indian J Ophthalmol. 2020 Sep. 68 (9):1818-1828. [Medline]. [Full Text].
Bonfioli AA, Orefice F. Toxoplasmosis. Semin Ophthalmol. 2005 Jul-Sep. 20(3):129-41. [Medline].
Burton BJ, Cunningham ET Jr, Cree IA, Pavesio CE. Eye involvement mimicking scleritis in a patient with chronic lymphocytic leukaemia. Br J Ophthalmol. 2005 Jun. 89(6):775-6. [Medline].
Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for scleritis. Ophthalmology. 1993 Sep. 100(9):1372-6. [Medline].
Jeon HS, Hyon JY, Kim MK, Chung TY, Yoon KC, Kim JY, et al. Efficacy and safety of immunosuppressive agents in the treatment of necrotising scleritis: a retrospective, multicentre study in Korea. Br J Ophthalmol. 2016 Aug. 100 (8):1066-70. [Medline].
McMullen M, Kovarik G, Hodge WG. Use of topical steroid therapy in the management of nonnecrotizing anterior scleritis. Can J Ophthalmol. 1999 Jun. 34(4):217-21. [Medline].
Bauer AM, Fiehn C, Becker MD. Celecoxib, a selective inhibitor of cyclooxygenase 2 for therapy of diffuse anterior scleritis. Am J Ophthalmol. 2005 Jun. 139(6):1086-9. [Medline].
Sainz de la Maza M, Molina N, Gonzalez-Gonzalez LA, Doctor PP, Tauber J, Foster CS. Scleritis therapy. Ophthalmology. 2012 Jan. 119(1):51-8. [Medline].
Sands DS, Chan SCY, Gottlieb CC. Methotrexate for the treatment of noninfectious scleritis. Can J Ophthalmol. 2018 Aug. 53 (4):349-353. [Medline].
Dutta Majumder P. Commentary: Rituximab in scleritis. Indian J Ophthalmol. 2020 Sep. 68 (9):1983-1985. [Medline]. [Full Text].

Media Gallery

of 0

Author

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Residency Directors in Emergency Medicine, Clerkship Directors in Emergency Medicine, Alliance for Clinical Education

Disclosure: Nothing to disclose.

Coauthor(s)

Diana Valcich, MD Attending Physician, Department of Emergency Medicine, North Shore LIJ Hospital System

Diana Valcich, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Program Director, Emergency Medicine, Einstein Medical Center Montgomery

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jerome FX Naradzay, MD, Loice Swisher, MD, and Jonathan Adler, MD, to the development and writing of this article.

Which clinical history findings are characteristic of scleritis?

Related Questions:

References

Tables

Contributor Information and Disclosures