DOCSLIB.ORG

Aging Female Patients Present New Clinical Challenges and Opportunities Ophthalmology Has a Role in Detecting Diseases of the Eye – and the Rest of the Body

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Aging Female Patients Present New Clinical Challenges and Opportunities Ophthalmology Has a Role in Detecting Diseases of the Eye – and the Rest of the Body Aging female patients present new clinical challenges and opportunities Ophthalmology has a role in detecting diseases of the eye – and the rest of the body Howard Larkin weight of babies, age of onset of ■ Use of hormone replacement “Ocular inflammation suggests McDonald MD, clinical professor in Chicago menopause and the use of therapy – oestrogen may play a risk for a wide range of of ophthalmology at Tulane hormone replacement therapy role in perfusion of the optic conditions,” she stressed. University, New Orleans. AS the French say:“Vive la have also been shown to be nerve, putting patients “LASIK causes dry eye, but the Différence.” significant predictors for receiving HRT at higher risk. Ocular signs of neurological outcomes are much worse if you Yet, as obvious as are the glaucoma and other eye diseases, disease go in with dry eye.” ■ biological differences between she points out. Birth weights of babies – Often, older patients experience Dr McDonald theorises that female and male, until recently In addition, diseases such as women who have delivered vague visual distortions and post-LASIK dry eye may result they were often, even rheumatoid arthritis (RA), which high birth-weight babies, those other visual impairments that from severing corneal nerve systematically, ignored in medical are more common among over 3.6 kg, are at higher risk may be early signs of endings when the flap is cut, and research. For example, from 1977 women, may present as for diabetes and may be at neurological disease, Dr Gordon destroying nerve bases during to 1986 women of childbearing ophthalmic complaints, says Janine higher risk for the progression notes. ablation. Dr McDonald’s research age were actually banned from A. Smith, MD Deputy Clinical of glaucoma. “Don’t assume it is because of suggests that conductive Phase 1 clinical trials in the Director of the National Eye a cataract or mild AMD.Ask if it keratoplasty may be a better United States. Institute in Bethesda, Maryland, In addition, female sex by itself option for treating hyperopia and is a significant factor in the could be a subtle double vision, “Men and women were seen to US. an optic neuropathy, or a visual presbyopia. LASEK may be better be biologically equivalent,” says “Perforation, corneal progression of low-tension for treating myopia because it glaucoma, Dr Higginbotham says. perceptual problem secondary to Eve J. Higginbotham MD, involvement, cataracts, glaucoma, a greater neurological problem.” eliminates damage induced by professor and chair at the optic nerve disease and detached cutting a flap, Dr McDonald says. Ocular inflammation and Sudden or transient loss of Department of Ophthalmology, retina are complications that can vision could be a sign of a University of Maryland School of result from RA.They require systemic autoimmune disease transient ischemic attack. Medicine Baltimore, addressing a systemic immune therapy to Identifying and promptly treating “We must study session at the annual meeting of treat.” Inflammatory conditions such as TIA is key to preventing strokes, the American Academy of Visual disturbances may also be scleritis, episcleritis, nodular which are the third leading cause sex at the cellular Ophthalmology dedicated to early signs of broader episcleritis and uveitis, and of mortality among women, and women’s health issues. neurological problems, including peripheral ulcerative keratitis are the risk increases with age. level. We have a not only more common in Nonetheless, about 1/3 of “Perforation, corneal involvement, women, they may be signs of an patients with TIA symptoms are long way to go in underlying rheumatoid arthritis not referred for neurological cataracts, glaucoma, optic nerve or other systemic condition, Dr testing, Dr Gordon says. our commitment Smith says. If so, systemic Alzheimer’s disease, HIV- disease and detached retina are autoimmune treatment is related dementia and other to discover when required. She recommends degenerative neurological complications that can result from RA. looking for the following: conditions may present as visual our differences disturbances resulting from a They require systemic immune ■ Scleritis with severe pain – loss of the ability to manipulate make a while pain and tenderness are visual information. Other therapy to treat.” hallmarks of scleritis, RA- symptoms of dementia include difference.” related scleritis tends to be memory loss, language more severe and painful. deterioration, poor judgment, That’s a problem because it just degenerative, cerebrovascular, restlessness and mood swings. These comments reflect just ■ Dry eye and mouth – may be isn’t true. Childbearing, hormone inflammatory and neoplastic The incidence of dementia is how far ophthalmology has come caused by Sjogren’s syndrome, changes and other unique disease. Early diagnosis is critical increasing, with the risk of in recognising and an autoimmune disorder that features of female biology have to reduce morbidity and Alzheimer’s doubling every five accommodating the needs of attacks the lachrymal and profound medical implications for mortality.As age increases, the years past age 65, Gordon says. females, particularly aging saliva glands. Sjogren’s may also everything from disease rates to risk of all these conditions rises, Double vision could indicate women. However, much remains appear in conjunction with RA pathology progression to emphasised Lynn K. Gordon MD, neoplastic brain cancers. to be discovered about how or other autoimmune treatment response.And since PhD, assistant professor of Impaired vision, visual female biology affects the eye, Dr disorders. women on average live longer ophthalmology at the University hallucinations and difficulty Higginbotham says. than men, as the population ages of California at Los Angeles “We must study sex at the ■ reading can also be associated it also becomes increasingly School of Medicine. Presence of arthritis – arthritis cellular level.We have a long way in conjunction with with neurological problems, Dr female. Dry eye is also more prevalent Gordon notes. to go in our commitment to The bottom line: understanding in older women than men, with inflammation of the eye and discover when our differences surrounding tissues could “Tuberculosis, HIV, and how female biology affects the implications for treatment of the vasculitis are all very important make a difference.” eyes is increasingly important for disease itself and for choosing indicate RA or even Wegener's granulomatosis. and their prevalence increases ophthalmologists to effectively refractive surgery techniques, she with age.” Eve J Higginbotham MD notes. [email protected] treat patients. It can help ■ Uveitis – may be associated physicians detect, diagnose and with a variety of autoimmune Dry eye and refractive Janine Smith, MD Taking the older female [email protected] treat not only eye diseases, but diseases including HLA-B surgery also systemic diseases that patient history related arthritis, even though Dry eye is about three times Marguerite McDonald present with visual symptoms. Many female-specific risk factors this condition is more more common in women than [email protected] Even though the study of for eye disease can be identified common in men. men and its incidence increases female ophthalmology was while taking the patient history, at menopause. Refractive delayed by wrong-headed Dr Higginbotham says. She Systemic lupus erythematosus surgeons operating on women research assumptions in the past, suggests exploring the following and sarcoidosis are also now over the age of 40 should also be much valuable research has been questions: being seen in older women, aware that LASIK surgery can done, Dr Higginbotham told the though both are more commonly provoke dry-eye, and it is much session. ■ Age of onset of menopause – seen in younger populations, Dr more likely to last longer in Nuclear and cortical cataracts women who undergo Smith says. older women already prone to and vascular AMD are more menopause before age 45 are the condition, says Marguerite common in women.The birth at higher risk for glaucoma. EuroTimes March 2006.
Load more

Recommended publications
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • Diagnosing, Treating, and Managing Scleritis in 2020 an Expert Panel Recommendation Panel Members Melissa Toyos, Md Stephen D
    DIAGNOSING, TREATING, AND MANAGING SCLERITIS IN 2020 AN EXPERT PANEL RECOMMENDATION PANEL MEMBERS MELISSA TOYOS, MD STEPHEN D. ANESI, MD, FACS n Partner and Director of Research n Massachusetts Eye Research & Surgery Institution n Toyos Clinic n Waltham, MA n Nashville, TN DAVID S. CHU, MD n Medical Director, Metropolitan Eye Research THOMAS A. ALBINI, MD & Surgery Institute n Professor of Clinical Ophthalmology n Associate Professor of Clinical Ophthalmology n University of Miami Health n Rutgers University n Bascom Palmer Eye Institute n Newark, NJ n Miami, FL ROBERT C. WANG, MD n Texas Retina Associates n Dallas, TX Corresponding Author: Melissa Toyos, MD; Toyos Clinic, Nashville, TN; [email protected]. This work was supported by an unrestricted medical writing grant from Mallinckrodt Pharmaceuticals and is based on a virtual roundtable discussion hosted by Evolve Medical Education LLC. Although uncommon, scleritis is a dangerous immune-me- DIAGNOSING SCLERITIS diated disease that can potentially threaten the structural Melissa Toyos, MD: What percentage of patients in integrity of the eye and may be indicative of potentially your practice have scleritis? life-threatening systemic vasculitis.1,2 Data on the genetic factors of scleritis is lacking, but it is thought that genes affect- Stephen D. Anesi, MD, FACS: Scleritis accounts for 10% ing systemic autoimmune diseases impact scleritis as well.2 to 15% of the patients I see in my practice. Differentiating between episcleritis and scleritis and posterior and anterior scleritis can be challenging for physicians. An David S. Chu, MD: I agree; 10% to 15% sounds right to accurate diagnosis is critical to properly treat the disease and me as well.
    [Show full text]
  • CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
    CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g.
    [Show full text]
  • Red Eye Sub-Conjunctival Hemorrhage
    AEP Course 1 Friday 1:00 - 2:00 pm Disclosures Red Eye • Consultant for Alcon Cecelia Koetting, OD FAAO Virginia Eye Consultants Norfolk, VA VOA Conference Norfolk 2018 Nothing makes the office more Multiple Causes of “Red Eye” nervous than when this walks in. • Sub-Conjunctival hemorrhage • Allergic Conjunctivitis • Viral Conjunctivitis • Bacterial Conjunctivitis • Episcleritis • Scleritis • Ocular Surface Disease How to Triage Sub-Conjunctival • On the phone • Get as much information as possible about which eye, Hemorrhage when, how, recent surgeries, recent trauma and what medications have been used • In the room • Gather the same information as well as details on symptoms • Help to avoid possible spread of bacterial and viral conjunctivitis 1 AEP Course 1 Friday 1:00 - 2:00 pm Causes • Straining from: • Broken blood vessel releasing blood into the • Coughing • Vomiting surrounding sub conjunctival tissue • Constipation • A bruise • Diarrhea • Lifting • More common in patients on blood thinners • Sneezing • Bruise more easily and will take longer to resolve • Rubbing the eyes • Contact lens • Severe dryness • Trauma, surgery, injections • Blood clotting disorders and blood thinners • Occasionally, high blood pressure High BP • Remember to ask if the patient is on blood thinners or blood pressure meds Allergic Conjunctivitis • Last time took BP meds • Possibly check BP in office if haven't taken • Inflammation in the lining of the conjunctiva from allergies • IgE and Mast Cell release • Symptoms: itching, redness, tearing, foreign body
    [Show full text]
  • Retina Associated with Systemic Diseases*
    MACULAR AND PARAMACULAR DETACHMENT OF THE NEUROSENSORY RETINA ASSOCIATED WITH SYSTEMIC DISEASES* BY Careen Y. Lowder, PhD, MD (BY INVITATION), Froncie A. Gutman, MD, Hernando Zegarra, MD (BY INVITATION), Z. Nicholas Zakov, MD (BY INVITATION)P James N. Lowder, MD (BY INVITATION), AND (BY INVITATION) John D. Clough, MD INTRODUCTION SEROUS RETINAL DETACHMENT (SRD) IN THE MACULAR REGION MAY DEVELOP AS A result of trauma, uveitis, optic neuritis, optic pit, and other conditions.1"2 In addition to these well-recognized disorders, there is a group ofpatients in whom transient episodes of SRD of the macula develop that are not presently associated with any recognized ocular or systemic disease. This group represents the clinical syndrome known as idiopathic central serous choroidopathy (CSC).2 The systemic implications of CSC are not known. Many reports have dealt with this without satisfactory evidence that there is a specific association between CSC and a systemic disease.1"3'4 This paper is a retrospective review of 168 cases of angiographically proved SRD of the macular region of unknown etiology that were seen at The Cleveland Clinic Foundation between 1971 and 1980. The associated systemic diseases were identified. Nine patients who had SRD of the posterior pole and subjective visual symptoms that appeared to correlate with an exacerbation oftheir system- ic diseases were included in the category of autoimmune disorders. Im- *From the Cleveland Clinic Foundation, Department of Ophthalmology, (Drs C. Lowder, Gutman, Zegarra, and Zakov), Department of Rheumatic and Immunologic Disease, (Dr Clough) and Department of Internal Medicine, University Hospitals,. (Dr J. Lowder) Cleveland, Ohio.
    [Show full text]
  • Ocular Manifestations of Systemic Lupus Erythematosus: a Review of the Literature Neal V
    Ocular Manifestations of Systemic Lupus Erythematosus: A Review of the Literature Neal V. Palejwala, Emory University Harpreet S. Walia, Emory University Steven Yeh, Emory University Journal Title: Autoimmune Diseases Volume: Volume 2012, Number 2012 Publisher: Hindawi Publishing Corporation | 2012-05-31, Pages 1-9 Type of Work: Article | Final Publisher PDF Publisher DOI: 10.1155/2012/290898 Permanent URL: http://pid.emory.edu/ark:/25593/d8q18 Final published version: http://www.hindawi.com/journals/ad/2012/290898/ Copyright information: © 2012 Neal V. Palejwala et al. This is an Open Access work distributed under the terms of the Creative Commons Attribution 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/). Accessed September 23, 2021 5:51 AM EDT Hindawi Publishing Corporation Autoimmune Diseases Volume 2012, Article ID 290898, 9 pages doi:10.1155/2012/290898 Review Article Ocular Manifestations of Systemic Lupus Erythematosus: A Review of the Literature Neal V. Palejwala, Harpreet S. Walia, and Steven Yeh Section of Vitreoretinal Disease and Surgery, Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, 30322 GA, USA Correspondence should be addressed to Steven Yeh, [email protected] Received 5 May 2012; Accepted 31 May 2012 Academic Editor: Hiroshi Okamoto Copyright © 2012 Neal V. Palejwala et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. About one-third of patients suffering from systemic lupus erythematosus have ocular manifestations. The most common manifestation is keratoconjunctivitis sicca. The most vision threatening are retinal vasculitis and optic neuritis/neuropathy.
    [Show full text]
  • Lacrimal Drainage Surgery in Wegener's Granulomatosis
    Br J Ophthalmol 2000;84:329–331 329 Lacrimal drainage surgery in Wegener’s Br J Ophthalmol: first published as 10.1136/bjo.84.3.329 on 1 March 2000. Downloaded from granulomatosis AnthonySLKwan,GeoVrey E Rose Abstract A small number of surgeons were involved, Aim—To examine the results of open all using the following technique. A linear lacrimal surgery in patients with Wegen- paranasal incision was followed by complete er’s granulomatosis. release of medial canthal tendon and a large Methods—A retrospective review of pa- rhinostomy was created, together with partial tients with Wegener’s granulomatosis who anterior ethmoidectomy. Anterior and poste- underwent lacrimal surgery over a 17 year rior flaps were formed from both nasal and lac- period. rimal sac mucosa and the anastomoses united Results—11 patients were identified and a with multiple 6/0 Vicryl (Ethicon) sutures. The total of 14 primary dacryocystorhinosto- medial canthal tendon, orbicularis, and skin mies (DCR) and one revisional DCR were were closed in layers and silicone stents used in performed; symptomatic relief was most cases. achieved in 13/14 operations and one patient required revisional surgery for persistent symptoms. There were no in- Results traoperative and few postoperative com- Eleven patients (eight males, three females) plications. are included in the study, aged between 34 Conclusions—In contrast with some pre- to 63 years (mean 52 years) at presen- vious reports, open DCR appears to be a tation. Wegener’s disease had been safe procedure and it is recommended as a present for an average of 9.8 years (range treatment for lacrimal obstruction in 4–22) and 9/11 patients were maintained on patients with Wegener’s granulomatosis, systemic immunosuppression before surgery.
    [Show full text]
  • Optic Neuritis As Ocular Manifestation of Wegener's Granulomatosis
    CASE REPORT DOI: 10.5603/OJ.2016.0021 Optic neuritis as ocular manifestation of Wegener’s granulomatosis — case report Dorota Borowicz, Edyta Koman, Katarzyna Nowomiejska, Robert Rejdak Department of General Ophthalmology, Medical University in Lublin, Poland ABSTRACT Wegener’s granulomatosis (WG) is a systemic, autoimmune, granulomatous necrotising inflammation of unk- nown aetiology. WG is described by the triad, which includes: rhinitis, and pulmonary and kidney dysfunction. The ocular signs are inflammatory orbital disease, nasolacrimal ducts obstruction, conjunctivitis, episcleritis, scleritis uveitis, retinal vasculitis, and optic neuritis. This article describes the case of a patient with optic neuritis associated with WG. KEY WORDS: Wegener’s granulomatosis, ophthalmic manifestations, c-ANCA Ophthalmol J 2016; Vol. 1, No. 3, 109–113 INTRODUCTION of WG are based on patient examination and lab- Wegener’s granulomatosis (WG) is a systemic, oratory tests, which include kidney parameters, autoimmune, granulomatous necrotising inflamma- radiogram of the lungs, and histopathological veri- tion and vasculitis (inflammation of the small to the fication. The specific marker of this disease is anti- medium vessels). The aetiology of this disease is un- bodies against cytoplasmic neutrophils (c-ANCA), known. The first case of this disease was described in which increases by 95% in the active phase and 1897 by Peter McBride who was a Scottish otolar- only 10-20% in the inactive phase of the disease. yngologist. Heinz Karl Ernst Klinger was a medical The positive c-ANCA is a useful tool for screening. student who added information on the anatomical The general treatment is based on glucocorticoids pathology in 1931. Frederick Wegener was a Ger- and cyclophosphamide [1, 3].
    [Show full text]
  • Table 1. Differential Diagnosis List of Acute Red Eye in Children, with Key Features and Management. Rows with Red Shading Denot
    ACUTE RED EYE IN CHILDREN CLINICAL Table 1. Differential diagnosis list of acute red eye in children, with key features and management. Rows with red shading denote sight-threatening conditions that require urgent referral to ophthalmology for confirmation of diagnosis and management. Key symptom Discharge Key features Diagnosis Management Painless Nil Blood under Subconjunctival Observation – should clear in bulbar conjunctiva; haemorrhage 1–3 weeks; if recurrent, investigate spontaneous or cause (eg bleeding disorder). Consider traumatic non-accidental injury. Watery First year of life; Nasolacrimal Instruct the parent to perform lacrimal elevated area over duct obstruction sac massage twice a week by pressing lacrimal sac his or her index finger on the child’s inner corner of eye in an inward and downward fashion. The majority of cases resolve within first year of life. Refer to ophthalmology for probe and syringing if persistent or there are signs of inflammation/infection. Irritation Nil Gritty sensation; Dry eye Regular lubricants including drops mild redness; mild and ointment at night depending vision reduction on the severity. If dosing of drops is frequent (more than six times per day), preservative-free artificial tears should be used. Check for the presence of contributing disorders such as blepharitis and treat accordingly. Nil Sectoral Episcleritis Observation. Lubricants if there is congestion of irritation. If it persists for more than episcleral vessels; one week, use a mild topical steroid unilateral; mild four times per day or oral nonsteroidal ocular tenderness anti-inflammatory drugs. Nil Eyelid nodule; mild Chalazion Conservative management with warm discomfort; single compresses and gentle massage or multiple in for five minutes, twice a day.
    [Show full text]
  • Chair-Side Reference: Corneal Ectatic Diseases and Thinning Disorders
    Chair-side Reference: Corneal ectatic diseases and thinning disorders Corneal ectatic and thinning disorders can be sight threatening. The addition of imaging technologies, such as corneal topography and/or optical coherence tomography (OCT), enable earlier diagnosis and an improved ability to monitor progression. Grading scales exist for more common ectatic diseases such as keratoconus; however there has not been a consensus on a grading scale. Keratoconus Age of onset: puberty. Progression typically occurs until 40 years of age. Bilateral, often asymmetric. Non-inflammatory, can be associated with systemic conditions including Down syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta. There is also an association with Atopy and ‘knuckle-rubbing’ Sagittal front corneal topography Anterior OCT and/or colour photography Description Forme Früste Typically refers to an “incomplete form” of keratoconus The term can describe either of the following: 1. Where the contralateral eye has keratoconus and the eye in question has: Normal corneal topography OCT findings are indistinguishable from a “normal” cornea 2. Some suspicious corneal topographical changes with no other clinical findings conclusive for a diagnosis of keratoconus The term “keratoconus suspect” is also used In earlier research, this was also referred to as Forme Früste keratopathy Early Slit lamp and OCT findings: Subtle signs of corneal thinning Topography: Abnormal elevation (steepening) of the anterior and posterior surfaces often resulting in an asymmetric
    [Show full text]
  • Scleritis and Episcleritis
    Brit. J. Ophthal. (I976) 6o, I 63 Br J Ophthalmol: first published as 10.1136/bjo.60.3.163 on 1 March 1976. Downloaded from Scleritis and episcleritis PETER G. WATSON* AND SOHAN SINGH HAYREHt From Moorfields Eye Hospital, City Road, London*, and Addenbrooke's Hospital, Cambridge*, and the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, USAt From the earliest available descriptions of episcleritis Leigh, I965), subconjunctival phlegma or simple (Slade, 1838; Rognetta, i844; Desmarres, 1847) or phlegmatous conjunctivitis by Mackenzie (I830), a confusion has existed between scleritis and and episcleritis periodica fugax by Fuchs (I895). episcleritis. This has led to contradictory views Duke-Elder and Leigh (I965) distinguished be- on the relative severity and prognosis of these tween nodular episcleritis and rheumatic episcleritis, conditions, and the erroneous belief that episcleritis but such a differentiation appears to be unjustified is accompanied by serious complications (Viswaling- as rheumatoid arthritis can be associated with ham, 1936; Wood, 1936; Mann and Markson, I950; either condition. We have classified episcleritis Clavel and Teulieres, 1958). While Slade (I838), into two types: Rognetta (i844), and Desmarres (I847), thought i. Simple episcleritis that episcleritis was both common and severe, 2. Nodular episcleritis. Mackenzie (i830) considered it to be neither and gave copyright. at the same time a vivid and accurate description SCLERITIS of scleritis. This confusion still persists today. In an attempt to clarify the position we have Many classifications of scleral disease have been been studying patients with scleritis and episcleritis proposed (Holthouse, I893; van der Hoeve, in a special clinic at Moorfields Eye Hospital 1934; Franceschetti and Bischler, I950; Duke- during the past io years.
    [Show full text]
  • Imitator of the Conjunctivitis: Bilateral Posterior Scleritis in a Child Patient
    Open Access Austin Journal of Clinical Ophthalmology Special Article - Ophthalmology: Clinical Cases and Images Imitator of the Conjunctivitis: Bilateral Posterior Scleritis in a Child Patient Resat Duman, Rahmi Duman*, Sibel İnan and Mustafa Doğan Abstract Department of Ophthalmology, School of Medicine, Conjunctivitis, keratitis, uveitis, episcleritis and scleritis are the most Afyon Kocatepe University, Turkey common causes of red eye. Painful red eye is the most common presentation *Corresponding author: Duman R, Department of of Posterior Scleritis (PS). PS rarely occurs in childhood. Herein, we report a Ophthalmology, School of Medicine, Afyon Kocatepe 13-year-old male who presented with visual loss, pain and redness. Following University, Ali Çetinkaya Kampusü, Izmir Karayolu 7. B-scan ultrasonography and optical coherence tomography examination of Km, Afyonkarahisar, Turkey the eyes, a diagnosis of posterior scleritis was made, and the patient was successfully treated with oral steroid therapy. Received: June 07, 2016; Accepted: July 19, 2016; Published: July 25, 2016 Keywords: Posterior scleritis; Conjunctivitis; Ultrasonography Introduction Conjunctivitis, keratitis, uveitis, episcleritis and scleritis are the most common causes of red eye. Painful red eye is the most common presentation of Posterior Scleritis (PS) [1]. Symptoms of PS include particular pain, blurred vision and photophobia. Posterior scleritis is a rare condition and generally associated with different systemic diseases such as rheumatoid arthritis and polyarthritis nodosa [2]. The rate of detectable sign of PS on the first examination is 83% [3]. The mean age at onset is 49 years [4]. PS occurrences in children are very rare and the ophthalmic literature consists of predominantly Figure 1: Fundus photography of the right eye showed a round-shaped choroidal mass of about three disc diameters in sizewith choroidal foldslocated single case reports.
    [Show full text]