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PurposeMethodsResultsConclusionTo report the long-term outcome of three refractory anterior scleritis cases successfully treated with tofacitinib, a Janus-associated kinase inhibitor.Three patients with systemic autoimmune disease-associated anterior scleritis (two with rheumatoid arthritis and one with systemic lupus erythematosus), resistant to conventional immunomodulatory therapy, were subsequently treated with tofacitinib (10 mg/day).Tofacitinib resulted in complete resolution of scleritis in all patients. During the 39–78 months of follow-up, no recurrence of scleritis occurred, and no adverse effects associated with tofacitinib were noted. At the last follow-up, all patients were free of scleritis with two patients receiving tofacitinib monotherapy and one without.Tofacitinib can be a safe and effective treatment for noninfectious refractory scleritis, warranting further investigation in large clinical trials. [ABSTRACT FROM AUTHOR]

To describe demographic and clinical characteristics as well as etiologies and visual outcomes of patients with scleritis. This is a descriptive, observational and retrospective study. We reviewed the electronic health records of patients with diagnosis of scleritis, who presented at the Institute of Ophthalmology Conde de Valenciana from January 2009 to December 2019. The cohort consisted of 162 patients with mean follow-up of 33.7 months. Mean age of scleritis presentation was 53.8 years. The most common type of scleritis was anterior nodular in 67 patients (41.3%). Most cases were idiopathic (52.4%). Visual outcomes were worse in anterior necrotizing scleritis. The most used drugs were oral NSAIDs and corticosteroids. The visual outcome in most patients is favorable, however it depends on scleritis type and etiology, with worse prognosis in anterior necrotizing scleritis forms and associated with autoimmune or systemic diseases. [ABSTRACT FROM AUTHOR]

This study presents two cases of idiopathic anterior scleritis in young female patients, one of whom progressed to necrotizing scleritis. Both cases posed significant diagnostic challenges and ultimately required immunomodulatory therapy after their respective inadequate responses to the initial standard treatments. Despite comprehensive laboratory evaluations, no underlying systemic etiology was identified in either patient. Pediatric anterior scleritis is extremely rare, and these cases underscore the importance of its early recognition and appropriate management to prevent sight-threatening and systemic complications., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, López-Fontanet et al.)

To present a case of necrotizing sclerokeratitis in a patient with multidrug-resistant tuberculosis and study the challenges in diagnosis and management of anterior tuberculous scleritis. Retrospective observational case report and review of anterior tuberculous scleritis. A 28-year-old woman, previously diagnosed as presumed tubercular panuveitis, presented with necrotizing sclerokeratitis and progressed to develop panophthalmitis. Laboratory investigations revealed multidrug-resistant Mycobacterium tuberculosis as the etiological agent. We reviewed cases of anterior tuberculous scleritis published in the literature, with regards to clinical features, microbiological investigations, treatment, and outcomes. Treatment includes standard antitubercular therapy, with or without systemic corticosteroids. Poor response to treatment is seen either due to delayed diagnosis or drug resistance, and the significance of the same is highlighted in our case. Diagnosis of tuberculous scleritis is a challenge. Therapeutic failure must alert the clinician for drug resistance which is diagnosed early, can prevent the devastating outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To report a novel case of bilateral anterior and posterior scleritis in a patient with acute myelogenous leukemia (AML). Observations: A 69-year-old African American man was admitted to the hospital for relapse of AML. After admission, but prior to induction of chemotherapy, the patient developed ocular redness and proptosis. The diagnosis of bilateral anterior and posterior scleritis was made following an ophthalmic examination, infectious and autoimmune lab work-up, and neuroimaging. The patient was administered immunosuppressive therapy, clinically monitored, and initiated on chemotherapy for AML relapse. About one week later, the patient showed clinical improvement and resolution of the scleritis and proptosis. Conclusion: Scleritis may present during AML relapse, and it may be due to a paraneoplastic syndrome or a reactive anti-leukemic inflammatory response. Clinicians should monitor patients with AML relapse for symptoms such as ocular redness, proptosis, pain, photophobia, and decreased vision, which may indicate development of scleritis.

BACKGROUND: The aims of this study was to report the clinical profile of five patients with features of anterior nodular scleritis as initial presentation in residents of Western Maharashtra. MATERIAL AND METHODS: A retrospective review of medical records was done from February 2019 to December 2019. Five new anterior nodular scleritis cases were reported at the tertiary-eye care centre within two months. The slit-lamp examination, anterior-segment photographs, and laboratory data were collected and analysed. RESULTS: A majority of cases (4/5) were presented in females. Three patients had a unilateral presentation, while 2 -- had bilateral involvement. The most common presenting symptom was ocular pain and redness. Corneal involvement was seen in 1 case. Two female patients were diagnosed with rheumatoid arthritis, one female had multinodular goitre, and the other two were idiopathic. Three patients responded very well to oral non-steroidal anti-inflammatory drugs (NSAIDs), while the rest two were managed with steroids. No patient had to be started on immunosuppressives. All the cases showed complete resolution with the treatment provided. All these patients presented at our centre in the autumn season. All these patients presented at our center in the autumn season only and no new case of anterior scleritis reported before or after this season. CONCLUSION: Management of scleritis may need a multidisciplinary approach as it may be the only presentation of an underlying systemic disease. It is to be considered in the differentials of red eye that presents with a substantial amount of ocular pain or with the known systemic disorder that leads to scleritis development. Also, there could be a seasonal association of anterior-nodular scleritis like episcleritis. [ABSTRACT FROM AUTHOR]

We herein report a case of a young female presenting with multiple nodular scleral abscesses mimicking infective scleritis with exudative retinal detachment. Repeated diagnostic scraping for microbiological and histopathological analysis was inconclusive. The patient’s systemic and collagen disease work-up was non-contributory. She was treated with multiple surgical debridement and de-roofing of the abscesses along with antibiotic irrigation. Topical and oral steroid was stopped on worsening of the condition, and the patient was maintained on topical and oral antibiotics. Complete resolution of scleritis and exudative detachment was noted at 1 month follow-up and no recurrence was noted until 6 months.

Scleritis is a rarely reported association of PV with only a few case reports describing it during the course of the disease.[[2]],[[6]],[[7]],[[8]] To the best of our knowledge, this is the first case of anterior scleritis in PV reported from western India. Generally, patients of PV present with oral lesions, which may precede cutaneous lesions by several months.[[1]] Ocular manifestations in PV are rare, the commonest reported being conjunctivitis.[[3]],[[4]] We report a rare occurrence of anterior scleritis in a patient with PV on immunosuppressive therapy. Keywords: Anterior scleritis; ocular manifestation; pemphigus vulgaris; rituximab EN Anterior scleritis ocular manifestation pemphigus vulgaris rituximab 2669 2671 3 07/15/22 20220701 NES 220701 Pemphigus vulgaris (PV) is a rare severe autoimmune disease that is characterized by painful blisters and erosions on the skin and mucous membranes.[[1]],[[2]] It is characterized by the loss of keratinocytes adhesion caused by circulating autoantibodies, mainly circulating IgG antibodies against desmoglein 3 or both desmoglein 1 and 3, the intercellular adhesion molecules. [Extracted from the article]

Purpose: To describe a case series of scleritis associated with IgA vasculitis (IgAV) at a tertiary referral center. Observations: Three men with scleritis associated with IgAV were identified: one with anterior scleritis alone, one with anterior scleritis and peripheral ulcerative keratitis (sclerokeratitis), and one with anterior and posterior scleritis. Visual acuity was preserved except from the patient who developed posterior scleritis. Ocular pain was the main symptom at presentation. All patients had a previous history of palpable purpura, but only one was aware of his underlying IgAV. Laboratory results revealed microhematuria and proteinuria with normal urinary β2 microglobulin levels and negative serum ANCAs. Skin or kidney biopsy demonstrated leukocytoclastic vasculitis or glomerulonephritis with dominant IgA immune deposits. Conclusions and Importance: Although uncommon, IgAV should be included in the differential diagnosis of anterior scleritis alone or associated with peripheral ulcerative keratitis or posterior scleritis, even in systemically asymptomatic patients. Urinalysis should not be underestimated in assessment of scleritis to detect early stages of glomerular disease. Scleritis may be the first manifestation whose study may lead to the diagnosis of IgAV. Multidisciplinary approach is necessary to prevent irreversible organ damage such as renal failure.

Rhegmatogenous retinal detachment (RRD) is an ocular emergency as it is sight-threatening and requires urgent surgical intervention. Ulcerative colitis (UC) is an immune-mediated inflammatory bowel disease that can present with ocular manifestations. The objective of this case report is to share the rare presentation of RRD associated with UC leading to diagnosis and management dilemmas. A 35-year-old man with active UC presented with a right chronic red eye for two months. The best corrected visual acuity (BCVA) was 6/6 in both eyes (OU). On examination, sectoral inferotemporal anterior scleritis (AS) with subclinical inferior RRD with peripheral holes in the lattice at the 6 o'clock position was noted. There was no posterior vitreous detachment. Optical coherence tomography (OCT) delineated the RRD objectively and was non-progressive for nine months. Barricade laser was given, in addition to intravenous methylprednisolone (IVMP), followed by a tapering dose of oral prednisolone and topical dexamethasone 0.1% over three months. Over a year, the scleritis resolved. However, six months later, while still on immunomodulating agents, the inferior RRD progressed on OCT. Segmental scleral buckle, indirect laser retinopexy, and subtenon triamcinolone injection were performed. IVMP 1 g per day was given for three days prior to surgery. Two months later, his BCVA was 6/6, with signs of fluid resorption and normal intraocular pressure. No recurrent AS was seen. Treatment of non-progressive, subclinical RRD patients with UC and active AS can be delayed with regular follow-up. When RRD progressed and there was no AS activity, it was the window of opportunity for the success of scleral buckle and perioperative steroids., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jayallan et al.)

Abstract Background Breast cancer is one of the commonest sources of ocular metastasis. Patients with ocular metastatic disease can present with a variable clinical picture. Patients with a history of breast cancer presenting with any eye symptom should be evaluated with consideration of ocular metastasis. Case presentation We report a case of ocular metastasis in a 46-year-old Brahmin woman presenting with right eye pain. She had been treated for stage IIIc left-sided breast cancer 2 years ago with six cycles of chemotherapy with docetaxel, adriamycin, and cyclophosphamide after undergoing modified radical mastectomy. An ophthalmic examination revealed a tender subconjunctival swelling superotemporally on retracting right upper eyelid. This finding alone indicated anterior scleritis. On examining fundus under mydriasis, an amelanotic subretinal mass could be visualized in the posterior pole superotemporal to macula. An orbital magnetic resonance imaging revealed a mass of 2 × 1 cm in size in the subretinal space of her right eye. Computed tomography of her chest was then done and showed multiple metastases in both lungs. Conclusion This case report highlights the fact that any unusual ocular presentation, even one simulating anterior scleritis, in a patient with a history of breast cancer should raise suspicion of metastasis.

Purpose: To report a case of pterygium surgery with conjunctival autograft followed by focal necrotizing scleritis due to foreign body entrapment in the scleral bed. Case Report/Results: This is a case report of a 76-years-old male patient who underwent nasal pterygium surgery and developed focal necrotizing scleritis secondary to foreign body entrapment under conjunctival autograft. One month following surgery, slit-lamp examination demonstrated a progressive thinning of the surgical area with focal inflammatory signs. A small synthetic fiber was identified to be trapped under the graft. A second intervention was performed with foreign body removal and a new conjunctival graft. Despite the surgery, focal scleral melting continued to progress and the patient was placed under systemic corticotherapy and submitted to amniotic membrane graft with epithelial side up. During the follow-up period there was a good tissue response. Conclusion: Despite being a safe and quick procedure, pterygium surgery can sometimes elicit new challenges.

A 14-year-old male teen presented with unilateral episcleritis, unresponsive to topical and systemic corticosteroid therapy, without a history of ocular trauma or evidence for systemic diseases. The presence of foreign bodies in the conjunctival mucus of the hyperemic fornix has been noticed during one of the follow-up examinations. The toxicological analysis of conjunctival mucus revealed the presence of ethylene glycolmonomethyl ether and triethilene glicolebuthyl ether, used as solvents in nail polish removers and all-purpose cleaners. An unexpected etiology of chemical self-inflicted episcleritis was determined. The teen was admitted to a psychological assessment, after which a psychotherapeutic treatment was recommended. Episcleritis is characterized by the acute onset of ocular pain and redness, with a frequent recurrent and stressful course. Since it can be associated with life-threatening systemic vasculitides, a prompt, aggressive immunosuppressive therapy may be considered, both for the ocular inflammation and for the underlying systemic condition. Rarely episcleritis does not improve despite topical and systemic therapy, administered in a stepladder way. The reported teenager case needed a complex multidisciplinary approach to achieve the correct diagnosis and to avoid unnecessary treatments. In the case of recognized “nonsuicidal self-injury,” a psychological evaluation is strongly recommended, to identify and address underlying neuropsychiatric problems.

Background: Breast cancer is one of the commonest sources of ocular metastasis. Patients with ocular metastatic disease can present with a variable clinical picture. Patients with a history of breast cancer presenting with any eye symptom should be evaluated with consideration of ocular metastasis.Case Presentation: We report a case of ocular metastasis in a 46-year-old Brahmin woman presenting with right eye pain. She had been treated for stage IIIc left-sided breast cancer 2 years ago with six cycles of chemotherapy with docetaxel, adriamycin, and cyclophosphamide after undergoing modified radical mastectomy. An ophthalmic examination revealed a tender subconjunctival swelling superotemporally on retracting right upper eyelid. This finding alone indicated anterior scleritis. On examining fundus under mydriasis, an amelanotic subretinal mass could be visualized in the posterior pole superotemporal to macula. An orbital magnetic resonance imaging revealed a mass of 2 × 1 cm in size in the subretinal space of her right eye. Computed tomography of her chest was then done and showed multiple metastases in both lungs.Conclusion: This case report highlights the fact that any unusual ocular presentation, even one simulating anterior scleritis, in a patient with a history of breast cancer should raise suspicion of metastasis. [ABSTRACT FROM AUTHOR]

Purpose To study high-resolution ultrasound biomicroscopy ( UBM) findings in anterior scleral inflammatory disease and evaluate the efficacy of high-resolution UBM as an adjunctive diagnostic tool. Methods A cross-sectional study. The medical records of 30 patients (33 eyes) with episcleritis or anterior scleritis were reviewed for clinical features and high-resolution UBM findings. Ultrasound biomicroscopy (UBM) examination was performed using 50 MHz Aviso S ( Quantel Medical, Clermont- Ferrand, France). Results Seventeen eyes had episcleritis [nodular (12), simple (five)], and 16 eyes had anterior scleritis [nodular (14), diffuse (two)] as classified by UBM. The use of high-resolution UBM allowed high-resolution imaging of the sclera and episclera and showed characteristic patterns of episcleritis and anterior scleritis. The clinical classification matched UBM findings in 25 (76%) eyes. In the other eight eyes (24%), UBM analysis led to a change in the final classification: four eyes with suspected episcleritis were classified with scleritis, and four eyes with suspected scleritis were classified with episcleritis. Eleven patients (36.7%) had an associated systemic disease. Conclusion High-resolution UBM enabled visualization of distinct imaging findings of episcleritis and anterior scleritis, indicating its usefulness in the classification of challenging cases of anterior scleral inflammatory disease. [ABSTRACT FROM AUTHOR]

A 14‑year‑old male teen presented with unilateral episcleritis, unresponsive to topical and systemic corticosteroid therapy, without a history of ocular trauma or evidence for systemic diseases. The presence of foreign bodies in the conjunctival mucus of the hyperemic fornix has been noticed during one of the follow‑up examinations. The toxicological analysis of conjunctival mucus revealed the presence of ethylene glycolmonomethyl ether and triethilene glicolebuthyl ether, used as solvents in nail polish removers and all‑purpose cleaners. An unexpected etiology of chemical self‑inflicted episcleritis was determined. The teen was admitted to a psychological assessment, after which a psychotherapeutic treatment was recommended. Episcleritis is characterized by the acute onset of ocular pain and redness, with a frequent recurrent and stressful course. Since it can be associated with life‑threatening systemic vasculitides, a prompt, aggressive immunosuppressive therapy may be considered, both for the ocular inflammation and for the underlying systemic condition. Rarely episcleritis does not improve despite topical and systemic therapy, administered in a stepladder way. The reported teenager case needed a complex multidisciplinary approach to achieve the correct diagnosis and to avoid unnecessary treatments. In the case of recognized “nonsuicidal self‑injury,” a psychological evaluation is strongly recommended, to identify and address underlying neuropsychiatric problems. [ABSTRACT FROM AUTHOR]

Episcleritis is synonymous with episclerokeratitis although the latter is most appropriate as the cornea is often affected as well as the episclera. Episcleritis is a superficial ocular disease characterized by inflammation of the episclera and conjunctiva. It responds most commonly to topical antinflammatory medications. In contrast scleritis is a granulomatous fulminant panophthalmitis that will progress rapidly and induce significant intraocular disease including glaucoma and exudative retinal detachments without systemic immune suppressive therapy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Ocular involvement in pemphigus vulgaris (PV) is relatively rare. The conjunctiva and eyelids are considered the most common affected sites in ocular pemphigus. Scleritis is rarely reported as a manifestation of PV. We present a case report of anterior scleritis as a manifestation of PV and its response to rituximab therapy. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this work was to analyze optical coherence tomography (OCT) findings compared to ophthalmic examination results in the management of anterior scleritis., Methods: We carried out a prospective study including patients presenting with anterior scleritis who underwent complete clinical examinations and OCT at baseline and at the final follow-up visit., Results: The mean age was 46years. The superior and temporal quadrants were clinically the most involved regions and showed the greatest thickness on the OCT images. Nodules were observed clinically in 6 patients, while OCT revealed them in 9 cases. OCT revealed 3 cases of sub-clinical necrosis. Separation of fibers, scleral edema, dilated vessels, fluid pockets and increased scleral thickness were the most common signs of the disease. Mean total scleral thickness and mean scleral-episcleral complex thickness were significantly improved after treatment (P=0.001 and P=0.00; respectively). Post-streptococcal syndrome (PSS) was diagnosed in 3 cases of non-necrotizing anterior scleritis. Necrotizing forms were low-grade and were associated with systemic diseases in 2 out of 3 patients. OCT signs persisted for a substantial time after resolution of clinical signs., Conclusion: OCT helped to distinguish necrosis and scleral nodules in subclinical cases. Non-necrotizing forms of scleritis supported the diagnosis of PSS, while necrotizing forms suggested systemic diseases. Complete resolution of a scleral inflammation could be followed more objectively with OCT than by clinical examination., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)