Clinical Characteristics of a Large Cohort of Patients with Scleritis and Episcleritis

Maza, Maite Sainz de la; Molina, Nicolas; González-González, Luis; Doctor, Priyanka; Tauber, Joseph; Foster, C. Stephen

doi:10.1016/j.ophtha.2011.07.013

Cited by 201 publications

(163 citation statements)

References 11 publications

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“…2,3,5 Furthermore, our results suggest that prior studies overestimate systemic disease associations and ocular complications, especially in episcleritis, likely due to referral bias. 2,3 For example, in contrast to a recent study from specialty eye care practices reporting that 15.3% of episcleritis patients suffered from a connective tissue or vasculitic disease, we found no such episcleritis patients. 3 The discrepancy in these findings may be due to referral of complicated episcleritis cases to tertiary care centers.…”

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confidence: 69%

“…1 Prior studies are limited to retrospective case series from tertiary care settings, which may overestimate ocular complications and systemic disease associations due to referral bias. 2,3 Therefore, there is a need for a population-based study describing the clinical characteristics of scleritis and episcleritis, including associated diagnoses, complications, and treatments. We used Kaiser Permanente Hawaii (KPH) as a source of data.…”

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confidence: 99%

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Clinical Characteristics of Scleritis and Episcleritis: Results from the Pacific Ocular Inflammation Study

Homayounfar

Borkar

Tham

et al. 2013

Ocular Immunology and Inflammation

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confidence: 69%

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confidence: 99%

Clinical Characteristics of Scleritis and Episcleritis: Results from the Pacific Ocular Inflammation Study

Homayounfar

Borkar

Tham

et al. 2013

Ocular Immunology and Inflammation

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“…The hypothesized pathophysiology is non-granulomatous inflammation of the superficial vascular network of the episclera that leads to vascular dilatation and perivascular infiltration [1]. …”

Section: Pathophysiologymentioning

confidence: 99%

“…Conjunctival culture or corneal staining are rarely needed. The use of phenylephrine hydrochloride 2.5% drops is helpful in distinguishing episcleritis (blood vessels blanch) from scleritis (does not blanch) [1] but not available at most primary care sites. Scleral biopsy should be done by an ophthalmologist if histologic diagnosis is needed due to failure of therapy.…”

Section: Diagnosismentioning

confidence: 99%

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Is this a worrisome red eye? Episcleritis in the primary care setting

Salama

Elsheikh

Alweis

2018

Journal of Community Hospital Internal Medicine Perspectives

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Episcleritis is the inflammation of the thin, loose, highly vascular connective tissue layer that lies between the conjunctiva and sclera. Incidence is less than 1/1000. It is more common in women and those between 40 and 50 years of age. Most cases are idiopathic. It is classified into simple and nodular. Most attacks resolve within 1–3 months. The nodular type tends to be more recurrent and painful. It presents with acute onset of redness, lacrimation, and photophobia. The diagnosis of is essentially clinical, and eye pain or tenderness should raise the concern for scleritis. Ophthalmological referral is recommended to rule out scleritis. Bloodwork to diagnose associated systemic rheumatological disease may be helpful. Cold compresses and artificial tears provide symptomatic relief. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids are used for persistent symptoms. Rarely, systemic steroids may be necessary. Immunosuppressive treatment to control an underlying autoimmune disorder is the last resort for resistant cases.

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Epidemiology of Scleritis in the United Kingdom From 1997 to 2018: Population‐Based Analysis of 11 Million Patients and Association Between Scleritis and Infectious and Immune‐Mediated Inflammatory Disease

Braithwaite

Adderley

Subramanian

et al. 2021

Arthritis & Rheumatology

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Objective To estimate 22‐year trends in the prevalence and incidence of scleritis, and the associations of scleritis with infectious and immune‐mediated inflammatory diseases (I‐IMIDs) in the UK. Methods The retrospective cross‐sectional and population cohort study (1997–2018) included 10,939,823 patients (2,946 incident scleritis cases) in The Health Improvement Network, a nationally representative primary care records database. The case–control and matched cohort study (1995–2019) included 3,005 incident scleritis cases and 12,020 control patients matched by age, sex, region, and Townsend deprivation index. Data were analyzed using multivariable Poisson regression, multivariable logistic regression, and Cox proportional hazards multivariable models adjusted for age, sex, Townsend deprivation index, race/ethnicity, smoking status, nation within the UK, and body mass index. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) were calculated. Results Scleritis incidence rates per 100,000 person‐years declined from 4.23 (95% CI 2.16–6.31) to 2.79 (95% CI 2.19–3.39) between 1997 and 2018. The prevalence of scleritis per 100,000 person‐years was 93.62 (95% CI 90.17–97.07) in 2018 (61,650 UK patients). Among 2,946 patients with incident scleritis, 1,831 (62.2%) were female, the mean ± SD age was 44.9 ± 17.6 years (range 1–93), and 1,257 (88.8%) were White. Higher risk of incident scleritis was associated with female sex (adjusted IRR 1.53 [95% CI 1.43–1.66], P < 0.001), Black race/ethnicity (adjusted IRR 1.52 [95% CI 1.14–2.01], P = 0.004 compared to White race/ethnicity), or South Asian race/ethnicity (adjusted IRR 1.50 [95% CI 1.19–1.90], P < 0.001 compared to White race/ethnicity), and older age (peak adjusted IRR 4.95 [95% CI 3.99–6.14], P < 0.001 for patients ages 51–60 years versus those ages ≤10 years). Compared to controls, scleritis patients had a 2‐fold increased risk of a prior I‐IMID diagnosis (17 I‐IMIDs, P < 0.001) and significantly increased risk of subsequent diagnosis (13 I‐IMIDs). The I‐IMIDs most strongly associated with scleritis included granulomatosis with polyangiitis, Behçet’s disease, and Sjögren’s syndrome. Conclusion From 1997 through 2018, the UK incidence of scleritis declined from 4.23 to 2.79/100,000 person‐years. Incident scleritis was associated with 19 I‐IMIDs, providing data for rational investigation and cross‐specialty engagement.

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Clinical Characteristics of a Large Cohort of Patients with Scleritis and Episcleritis

Cited by 201 publications

References 11 publications

Clinical Characteristics of Scleritis and Episcleritis: Results from the Pacific Ocular Inflammation Study

Clinical Characteristics of Scleritis and Episcleritis: Results from the Pacific Ocular Inflammation Study

Is this a worrisome red eye? Episcleritis in the primary care setting

Epidemiology of Scleritis in the United Kingdom From 1997 to 2018: Population‐Based Analysis of 11 Million Patients and Association Between Scleritis and Infectious and Immune‐Mediated Inflammatory Disease

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