Scleritis associated more often with ocular complications than episcleritis

This large retrospective case series published in the January issue of Ophthalmology provides an up-to-date evaluation of the demographic characteristics, clinical features, risk factors for decreased vision, ocular complications and disease associations of patients with scleritis and episcleritis. The authors found that scleritis is associated more often with ocular complications than episcleritis. It's an important distinction because of the differences in probability of ocular complications that can reduce vision. This series also reports on the risk factors for decreased vision in scleritis patients.

The authors reviewed the records of 500 patients with scleritis and 85 patients with episcleritis seen at two tertiary referral centers, one in Cambridge, Mass., and one in Barcelona, Spain. They found that scleritis is associated more often with ocular complications than episcleritis (45.0 vs. 19.0 percent; P < 0.0001), and necrotizing scleritis is the scleritis type most often associated with ocular complications (90 percent) and with specific ocular or systemic disease deemed relevant by the researchers (80 percent; P < 0.001 for each).

Ocular complications seen more frequently in patients with scleritis than episcleritis include anterior uveitis (26.4 vs. 16.5 percent), peripheral ulcerative keratitis (7.4 vs. 0 percent), ocular hypertension (14.2 vs. 3.5 percent) and a decrease in vision (15.8 vs. 2.3 percent; P < 0.0001 for each). Disease association was found in 35.8 percent of patients with scleritis versus 27.1 percent with episcleritis. This included connective tissue or vasculitic diseases in 24.8 vs. 15.3 percent, respectively. Scleritis preceded systemic disease diagnosis in 38.7 percent of patients.

The authors conclude that increased awareness of the risk factors for decreased vision among scleritis patients will lead to treatment and referral patterns with the best chance of minimizing the likelihood of visual impairment.