Search

We describe a 19-year-old indigenous male with no relevant medical history who presented with chronic symptoms of headache, fever, weight loss, blurred vision, and conjunctival mass who was diagnosed with disseminated tuberculosis (TB). Extensive ocular involvement, including multifocal choroiditis and nodular episcleritis, in addition to brain, spinal cord, lung, and gastrointestinal tract involvement were identified. Ocular tuberculosis (OTB) is a rare presentation of extrapulmonary manifestations, with choroiditis being the most common. Nodular episcleritis has been rarely reported in some cases in the literature. This case highlights the importance of suspecting tuberculosis in immunocompetent patients, from endemic countries, with a history of contact with a confirmed case of TB, with associated pulmonary involvement or prolonged episcleritis. [ABSTRACT FROM AUTHOR]

Background and objectives: The initial symptom that triggers granulomatosis with polyangiitis (GPA) diagnosis is rarely ocular. We describe a case with a single ocular lesion identified as probable GPA due to proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA)-positivity according to the diagnostic criteria of the Ministry of Health in Japan; the lesion repeatedly worsened. Materials and methods: A 25-year-old female visited the Department of Ophthalmology, Asahi General Hospital, with upper eyelid swelling and conjunctival and episcleral hyperemia of the left eye. Both hordeolum and eyelid cellulitis were suspected, as the condition was resistant to treatment with antibiotic eye drops. Episcleritis was suspected due to localized hyperemia in the upper part of the eye. Upon treatment with antibacterial agents and steroid eye drops, the swelling and the hyperemia repeatedly worsened every week. Results: Blood samples were positive for PR3-ANCA, and GPA with an isolated ocular lesion was considered. After oral steroid treatment, the patient had no recurrence for 4 years. There was no systemic involvement in the upper respiratory tract, lungs, or kidneys. Conclusions: Diagnosing GPA with ocular symptoms as initial manifestations is challenging. GPA should be considered in treatment-resistant eyelid, orbital, and episcleral lesions, even at a young age. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo study clinical characteristics and management outcomes of cases of ocular syphilis co-presenting with scleritis and active uveitis.A retrospective analysis of cases diagnosed with ocular syphilis between January 2020 and December 2023 was conducted at a tertiary eye care centre. Clinical records, investigations, and outcomes were reviewed to identify cases with scleritis with active uveitis. Demographic data, clinical features, treatment modalities, and resolution patterns were analyzed.Among the 135 eyes of 95 cases of ocular syphilis studied, scleritis with uveitis was observed in 3.70% of eyes (five eyes). All cases with scleritis and uveitis were unilateral and male, with ages ranging from 32 to 61 years. Concurrent features included placoid chorioretinitis, retinal vasculitis, and anterior uveitis. Misdiagnosis with subsequent oral steroid therapy precipitated scleritis as an exacerbation in two cases. Three cases, which were previously undiagnosed, were found to be HIV-positive. Scleritis manifested as anterior, non-necrotizing inflammation, often accompanied by chemosis, and responded rapidly to antibiotic and non-steroidal anti-inflammatory therapy. Scleritis resolution preceded that of chorioretinitis and retinal vasculitis.Non-necrotizing anterior scleritis with chemosis can be a rare presentation of active syphilitic uveitis. Large placoid chorioretinitis lesions, preceding inadvertent oral steroid and/or undiagnosed HIV status were the possible risk factors for the development of concurrent scleritis. [ABSTRACT FROM AUTHOR]

Episcleritis is an inflammatory condition affecting the episclera of the eye, which is the tissue between the sclera and conjunctiva. It manifests as unilateral or bilateral redness and discomfort. Despite its typically benign course, it may signal underlying systemic disorders, necessitating comprehensive evaluation and personalized management. While most cases are idiopathic, autoimmune diseases and infections may play contributory roles. Epidemiological studies reveal a predilection for young to middle-aged females, with episcleritis being less common in children. Diagnostically, characteristic features include sectoral redness and mild discomfort, distinguishing it from conjunctivitis and scleritis. Treatment primarily focuses on symptomatic relief, utilizing topical steroids, oral NSAIDs, and artificial tears. The prognosis is generally favourable, with spontaneous resolution within weeks; however, recurrent, or chronic cases may necessitate further evaluation for underlying systemic conditions. This comprehensive review aims to elucidate etiology, epidemiology, diagnosis, management strategies, prognosis of episcleritis, and clinical nuances, drawing upon recent literature from 1976 to the present. By consolidating contemporary knowledge, this review provides valuable insights for clinicians on how to treat this ocular condition effectively.

Abstract Background Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. Body The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. Conclusions We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.

The outcomes and complications of the coronavirus infection are of interest to specialists in many fields of medicine, including ophthalmologists.Purpose: to analyze the clinical features of ophthalmic complications in patients with coronavirus infection COVID-19.Materials and methods. Four patients aged 37 to 70 years with ophthalmic inflammatory complications with coronavirus infection were examined and treated.Results. In 2 cases, eye damage was observed in the acute phase of COVID infection. It included deep keratitis, iridocyclitis, and exacerbation of rhinosinusitis complicated by osteomyelitis, orbital phlegmon with loss of vision. In the remaining 2 cases, in the post-COVID period (2 and 5 months after the disease, respectively), acute dacryoadenitis with the dry eye syndrome and subacute episcleritis was observed. In addition to anti-COVID therapy, all patients underwent specific ophthalmic therapy, which in 1 case included surgical intervention.Conclusion. The cases presented demonstrate eye damage against the background of coronavirus infection with the involvement of various eye structures into the inflammatory process. The ophthalmological manifestations were severe, with complications in the acute phase of COVID and in the early post-COVID period. Clinical observations indicate the need for additional specific therapy of coronavirus infection complications, along with the basic anti-COVID treatment.

Purpose: To report the prevalence of scleritis and episcleritis in patients with idiopathic small fiber neuropathy (SFN). Methods: The Mass General Brigham (MGB) hospital database was queried for patients with SFN, scleritis and episcleritis using diagnostic codes and natural language processing. Electronic medical chart review of patients diagnosed with SFN and episcleritis/scleritis who had at least one ophthalmology visit was conducted. The prevalence of scleritis and episcleritis in patients diagnosed with SFN was compared to those without SFN using logistic regression to adjust for covariates. All statistical analyses were performed in RStudio 4.2.1. Results: From the 2100 SFN patients with an eye exam in the MGB database, 23 patients had episcleritis or scleritis (1.1 %) confirmed by chart review. Ten patients had episcleritis (0.48 %) and thirteen patients had scleritis (0.62 %). Of the episcleritis and scleritis patients, 16 (69.6 %) were women and 7 (30.4 %) were men. Ten (43.5 %) had bilateral ocular disease. The mean age of ocular diagnosis was 51.0 years (range, 22–77 years). Out of the 507,128 controls without SFN in the MGB database, 1481 (0.29 %) had scleritis and 1430 (0.28 %) had episcleritis. Episcleritis and scleritis were more prevalent in patients with SFN than in those without SFN: 0.48 % vs. 0.28 % for episcleritis and 0.62 % vs 0.29 % for scleritis (P values = 0.32 and 0.02, respectively). Conclusions and Importance: There were higher rates of scleritis in SFN patients compared to non-SFN patients. This potential systemic disease association had not been previously reported.

Nodular granulomatous episcleritis (NGE) typically presents as an elevated mass or elevated masses at the limbus and often infiltrates the cornea (episclerokeratitis). In the current report, a granulomatous lesion was observed subretinally in the right eye (OD) of a 5‐year‐old male castrated American Staffordshire Terrier dog. There was concurrent retinal hemorrhage and detachment OD; the right eye was not visual. Due to poor prognosis for vision and potential for a neoplastic etiology of the mass, staging with higher imaging was recommended but declined by the owner. Therefore, an enucleation was performed. Histopathology of the globe identified a subretinal mass, marked histiocytic and lesser lymphoplasmacytic choroiditis, posterior episcleritis, and optic neuritis with retinal detachment. The subretinal mass was composed of densely packed, large, spindle histiocytes mixed with occasional lymphocytes, plasma cells, and only rare neutrophils. Regions of the mass showed lymphocytes aggregate to form nodules. This histological presentation was a type of proliferative histiocytic disease with similarities to nodular granulomatous episcleritis or granulomatous/necrotizing scleritis. This is a novel presentation of NGE‐like progression to subretinal scleral, choroidal, and retinal involvement and provides a new differential possibility for posterior segment masses observed on fundic examination. [ABSTRACT FROM AUTHOR]

Introduction: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that often causes ocular complications, of which keratoconjunctivitis sicca (KCS), scleritis and episcleritis are the most common entities. When left untreated, they can adversely affect eye health and cause vision loss in severe cases. Therefore, early and effective treatment of ophthalmic complications may significantly improve visual outcomes in patients with rheumatoid arthritis. Aim of the study: The aim of the study was to compile and analyze the current literature on the treatment of the most prevalent ocular manifestation associated with RA. Special emphasis was placed on recently approved drugs and those in late-stage clinical trials. Methods and materials: Publication research was conducted using the PubMed database and Google Scholar with a primary focus on literature from the past 10 years. Firstly, common ocular complications of rheumatoid arthritis were identified, and relevant treatment modalities were extracted for further analysis. Finally, the names of relevant drugs or drug classes were used along with the names of the aforementioned disease entities to discover clinical trials regarding their efficacy and safety. Additionally, references from selected manuscripts were included. Summary: The landscape of treatment for ocular complications associated with RA offers a promising future for patients and clinicians. Three new therapeutic modalities for dry eye disease have been approved in 2023, and three additional drugs are in late-stage clinical trials. Furthermore, recent advances in biologic therapy have shown considerable promise in treating scleritis, especially in patients refractory to conventional treatment or with severe symptoms of the disease. [ABSTRACT FROM AUTHOR]

Background: Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. Body: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. Conclusions: We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis. [ABSTRACT FROM AUTHOR]

Background and objectives: The initial symptom that triggers granulomatosis with polyangiitis (GPA) diagnosis is rarely ocular. We describe a case with a single ocular lesion identified as probable GPA due to proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA)-positivity according to the diagnostic criteria of the Ministry of Health in Japan; the lesion repeatedly worsened. Materials and methods: A 25-year-old female visited the Department of Ophthalmology, Asahi General Hospital, with upper eyelid swelling and conjunctival and episcleral hyperemia of the left eye. Both hordeolum and eyelid cellulitis were suspected, as the condition was resistant to treatment with antibiotic eye drops. Episcleritis was suspected due to localized hyperemia in the upper part of the eye. Upon treatment with antibacterial agents and steroid eye drops, the swelling and the hyperemia repeatedly worsened every week. Results: Blood samples were positive for PR3-ANCA, and GPA with an isolated ocular lesion was considered. After oral steroid treatment, the patient had no recurrence for 4 years. There was no systemic involvement in the upper respiratory tract, lungs, or kidneys. Conclusions: Diagnosing GPA with ocular symptoms as initial manifestations is challenging. GPA should be considered in treatment-resistant eyelid, orbital, and episcleral lesions, even at a young age.

Scleritis is an inflammation of the episcleral and scleral tissues, characterized by injection in both superficial and deep episcleral vessels. When only episcleral tissue is involved, it is referred to as episcleritis. Episcleritis is mainly idiopathic but may be secondary to an underlying rheumatologic disease. Despite being rare, drug-associated episcleritis and scleritis should also be included in the differential diagnosis. Tumor necrosis factor-alpha (TNF-α) inhibitors are generally well-tolerated, but etanercept, in particular, has the potential to cause paradoxical adverse reactions including ocular inflammations, such as uveitis, scleritis, and ocular myositis. Etanercept differs in its mechanism of action from other TNF-α inhibitors as it acts as a decoy receptor, and this may partly explain the more frequently reported etanercept-associated ocular inflammation. Etanercept may also be ineffective in preventing ocular inflammation. However, the dechallenge and rechallenge phenomena have proven there is a causative link between etanercept and new-onset ocular inflammation. We report a case of a 15-year-old boy with enthesitis-related arthritis and familial Mediterranean fever who presented with episcleritis and blepharitis while receiving etanercept treatment and subsequently showed dechallenge and rechallenge reactions. Therefore, physicians should also be aware that episcleritis should be considered a paradoxical adverse reaction to etanercept and can occur in pediatric patients. We also reviewed the English literature to provide an overview and evaluate intervention options. [ABSTRACT FROM AUTHOR]

Background and aims: Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn's disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. Methods: PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. Results: The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs' pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs. [ABSTRACT FROM AUTHOR]

Purpose: To report demographic characteristics and ophthalmological manifestations of patients with granulomatosis with polyangiitis (GPA) in a tertiary eye care center in Turkey. Methods: Medical records of patients with GPA-related ocular manifestations evaluated between 2013 and 2023 were included. Demographic and clinical characteristics of the patients including nature of systemic involvement, ophthalmologic symptoms and signs, laboratory investigations and treatment modality were reviewed. Results: Twelve eyes of 10 patients (5 female/5 male) were included. The mean age was 57.2 ± 12.2 (35–71) years. Five (50%) patients were already diagnosed with GPA. Ocular involvement was the first manifestation of GPA in 3 patients. The remaining 2 patients had simultaneous systemic and ocular symptoms at presentation. Conjunctival hyperemia (9 eyes) and pain (7 eyes) were the most frequent presenting symptoms followed by blurred vision (3 eyes). The frequencies of ocular manifestations were as follows:episcleritis (3 eyes), isolated peripheral ulcerative keratitis (PUK) (3 eyes), scleritis (3 eyes), simultaneous PUK and scleritis (2 eyes) and periorbital mass (1 eye). Conclusion: Ophthalmological manifestations can be the initial findings in GPA. Since GPA can affect different structures of the eye, it sometimes might be challenging for ophthalmologists. Therefore, it is crucial for ophthalmologists to be well-informed about GPA-related ocular findings and to have a high index of suspicion for GPA. Although PUK associated with scleritis is highly suggestive for GPA, isolated cases of PUK or scleritis can be seen in GPA. Therefore, it is important to adopt a multidisciplinary approach, consider GPA in differential diagnosis, and benefit from accurate diagnostic tests. [ABSTRACT FROM AUTHOR]

Les sclérites et épisclérites sont des maladies inflammatoires oculaires rares mais qui méritent d'être connues des internistes du fait de leur association fréquente à des maladies systémiques auto-immunes ou inflammatoires. Leur distinction par l'interrogatoire et l'examen ophtalmologique est importante car leur prise en charge, leur pronostic et leurs complications potentielles sont très différents. L'épisclérite représente une inflammation oculaire superficielle, de bon pronostic visuel avec un traitement souvent local, habituellement sans complication. Elle est très rarement associée à une maladie systémique auto-immune. En revanche, la sclérite est une atteinte ophtalmologique potentiellement grave qui peut menacer le pronostic visuel en l'absence de traitement systémique adapté. Elle est associée à une maladie sous-jacente dans 40 à 50 % des cas, en particulier une maladie systémique auto-immune (25 à 35 % des cas) ou une cause infectieuse (5 à 10 % des cas). La polyarthrite rhumatoïde et les vascularites systémiques, en particulier les vascularites associées aux anticorps anti-cytoplasme des polynucléaires neutrophiles (ANCA), sont les principales causes auto-immunes de sclérites et d'épisclérites. Les sclérites peuvent constituer une porte d'entrée révélatrice de la maladie auto-immune sous-jacente et imposent des explorations étiologiques systématiques. Elles nécessitent dans les formes agressives, compliquées, réfractaires ou associées à une maladie systémique auto-immune, le recours à une corticothérapie générale, voire un traitement immunosuppresseur, ainsi qu'une étroite collaboration entre ophtalmologues et internistes. L'avènement des biothérapies offre de nouveaux outils thérapeutiques efficaces dans la prise en charge de ces cas difficiles. Scleritis and episcleritis are rare ocular inflammatory diseases but deserve to be known by internists because of their frequent association with systemic autoimmune diseases. It is important to distinguish them between because their prognosis, therapeutic management and potential complications are very different. Episcleritis represents a superficial ocular inflammation with usually benign visual prognosis, no complication with local treatment, and is associated with a systemic autoimmune disease in rare cases. In contrast, scleritis is a potentially serious ophthalmological condition that can threaten the visual prognosis in the absence of appropriate systemic treatment. It is associated with an underlying disease in 40–50% of cases, in particular a systemic autoimmune disease (25–35% of cases) or an infectious cause (5–10% of cases). Rheumatoid arthritis and systemic vasculitides, particularly antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides, are the main autoimmune causes of scleritis and episcleritis. Scleritis can reveal the underlying autoimmune disease and requires systematic etiological investigations. Aggressive, complicated, refractory forms or those associated with a systemic autoimmune disease require glucocorticoids or even immunosuppressants, and close collaboration between ophthalmologists and internists is required. The development of biologic agents offers new effective therapeutic tools in the management of these difficult cases. [ABSTRACT FROM AUTHOR]

Introduction: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that often causes ocular complications, of which keratoconjunctivitis sicca (KCS), scleritis and episcleritis are the most common entities. When left untreated, they can adversely affect eye health and cause vision loss in severe cases. Therefore, early and effective treatment of ophthalmic complications may significantly improve visual outcomes in patients with rheumatoid arthritis. Aim of the study: The aim of the study was to compile and analyze the current literature on the treatment of the most prevalent ocular manifestation associated with RA. Special emphasis was placed on recently approved drugs and those in late-stage clinical trials. Methods and materials: Publication research was conducted using the PubMed database and Google Scholar with a primary focus on literature from the past 10 years. Firstly, common ocular complications of rheumatoid arthritis were identified and relevant treatment modalities were extracted for further analysis. Finally, the names of relevant drugs or drug classes were used along with the names of the aforementioned disease entities to discover clinical trials regarding their efficacy and safety. Additionally, references from selected manuscripts were included. Summary: The landscape of treatment for ocular complications associated with RA offers a promising future for patients and clinicians. Three new therapeutic modalities for dry eye disease have been approved in 2023, and three additional drugs are in late-stage clinical trials. Furthermore, recent advances in biologic therapy have shown considerable promise in treating scleritis, especially in patients refractory to conventional treatment or with severe symptoms of the disease.

Between 3-47% of patients with inflammatory bowel disease (IBD) have extraintestinal manifestations (EIMs), and between 1.3-86.9% of patients with IBD suffer from ocular EIMs (O-EIMs) making the eye the third most common organ affected. These O-EIMs exist among a spectrum, with a variety of types and amounts of inflammation which can lead to decreased vision, and in some cases, vision loss, without treatment. We performed a literature review concerning O-EIMs in patients who had or were later found to have a diagnosis of IBD in order to identify ocular EIMs that commonly occur with IBD and to assess which patients with IBD may be at higher risk of developing O-EIMs. We were also interested in ascertaining whether O-EIMs were more common in specific populations of people or in specific subtypes of IBD. Lastly, we explored the common treatments of O-EIMs in patients with IBD. Upon review of the literature, we found that the most common O-EIMs are episcleritis and uveitis. Anterior uveitis is more commonly seen, although, inflammation may occur in the posterior segment of the eye as well and may also manifest as retinal vasculitis. While these diagnoses are sometimes known retrospectively, most patients present with nonspecific eye complaints of which decreased vision with or without pain is the most common. Visual symptoms associated with ocular EIMs may be non-specific so physicians should have a low threshold to refer to ophthalmology for visual complaints. It is important to keep in mind that ocular EIMs can cluster with skin and joint EIMs. Screening should be prioritized for female patients with Crohn’s disease and concurrent arthritis. Treatments for O-EIMs are outlined and compared in this paper as well.

Introduction: The association of human immunodeficiency virus (HIV) infection with the development of autoimmune disorders or systemic diseases is intriguing. Here, we describe a case of HIVpositive individual, who developed a bullous pemphigoid with several autoimmune disorders. Case description: A 58 year-old man was admitted to infectious diseases department in June, 2020 due to fever and blistering skin lesions. After several investigations, diagnosis of HIV infection and nodal tuberculosis as opportunistic infection, associated with a bullous pemphigoid was made. Topical corticosteroids and anti-tuberculosis therapy began in June, 2020. Antiretroviral therapy started in August, 2020, with a good virological response. Four months later, in December 2020, the patient developed polyarthralgia and bilateral episcleritis. Testing for anti-nuclear antibodies and rheumatoid factors were positive. Autoimmune diseases were suspected, and the patient was treated with oral corticosteroids for two months with favorable outcome. However, in July, 2021, after the end of corticotherapy, clinical signs reappeared and the patient died of an acute kidney failure. Conclusions: Pathophysiology of autoimmune diseases in HIV population remains uncertain. There are several issues that need further studies regarding therapy, especially when systemic corticosteroids and immunosuppressive drugs are under consideration. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID-19) vaccines have been reported to have ocular side effects including scleritis and episcleritis. To report scleritis and episcleritis within a month following administration of COVID-19 vaccine. Retrospective case series. 15 eyes of 12 consecutive patients with scleritis and episcleritis from March 2021 to September 2021 were included. The mean time of onset of symptoms in patients with scleritis was 15.7 days (range, 4–30) and for episcleritis it was 13.2 days (range 2–30). Patients received COVISHIELD™ (10 patients) and COVAXIN™ (2 patients). Five patients had denovo inflammation and seven had recurrent inflammation. Episcleritis patients were treated with topical steroids and systemic COX2 inhibitors while patients with scleritis were treated with topical steroids/oral steroids/antiviral medications depending on the aetiology. Scleritis and episcleritis following COVID-19 vaccination are milder and do not require intensive immunosuppression except in rare cases. [ABSTRACT FROM AUTHOR]

Purpose of Review: Provide a framework for recognizing key symptoms and clinical findings in patients with autoimmune inflammatory eye disease. Recent Findings: The most common manifestations of autoimmune inflammatory eye disease are episcleritis, scleritis, uveitis (anterior, intermediate, posterior, and panuveitis), and keratoconjunctivitis sicca. Etiologies can be idiopathic or in association with a systemic autoimmune condition. Referral of patients who may have scleritis is critical for patients presenting with red eyes. Referral of patients who may have uveitis is critical for patients presenting often with floaters and vision complaints. Attention should also be directed to aspects of the history that might suggest a diagnosis of a systemic autoimmune condition, immunosuppression, drug-induced uveitis, or the possibility of a masquerade condition. Infectious etiologies should be ruled out in all cases. Summary: Patients with autoimmune inflammatory eye disease may present with ocular or systemic symptoms alone, or in combination. Collaboration with ophthalmologists and other relevant specialists is vital to optimal long-term medical care. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to investigate the course of uveal manifestations in a cohort of patients who underwent surgery for ulcerative colitis (UC), highlighting the diverse spectrum of associated eye disorders and alerting clinicians of their significance. Patients and methods A retrospective observational study was conducted on 40 UC patients with ocular manifestations who underwent one-stage laparoscopic restorative proctocolectomy according to the European Crohn's and Colitis Organization (ECCO) guidelines. Ophthalmic examinations were performed preoperatively and postoperatively during the 6-month follow-up period. Anterior uveitis attacks were graded based on the presence of cells or flares, vitreous haze indicates intermediate uveitis while posterior uveitis was indicated by retinitis or choroiditis, or both. Recurrence was a Standardization of Uveitis Nomenclature (SUN) grading system score greater than or equal to 2+ for anterior chamber cells or vitreous haze. Results Postoperatively, uveitis regression was observed in ~60% of the patients, 25% showed a stationary course, and 15% exhibited progression. After surgery, more patients had lower Standardization of Uveitis Nomenclature grades for anterior chamber cells, flares, and vitreous haze than at baseline. Conclusion Ulcerative colitis can manifest with various ophthalmic manifestations ranging from nonspecific to severe, affecting visual prognosis or remaining asymptomatic. In our study most patients who underwent colonic surgery got benefits in the form of not only decreasing the severity of disease activity but also a decrease in the recurrence rate postsurgical. [ABSTRACT FROM AUTHOR]

Aaron Veenis, Megan Haghnegahdar, Radwan Ajlan Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USACorrespondence: Radwan Ajlan, Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, Kansas City, KS, 66208, USA, Tel +1 913-588-6600, Fax +1 913-588-6655, Email rajlan@kumc.eduPurpose: The Coronavirus Disease 2019 (COVID-19) pandemic spurred vaccine development and resulted in the development of the novel mRNA COVID-19 vaccine and with it, a growing public concern of vaccine side effects. There are reports of ocular inflammatory processes such as episcleritis being possible side effects of COVID-19 vaccination. Here we reported the first case of unilateral episcleritis in a Crohn’s disease patient following her third mRNA COVID-19 vaccination booster shot.Patient and Methods: A 27-year-old female presented with a 1-day history of right eye redness, itching, and burning. Patient reported developing these symptoms within 3– 4 hours after vaccination. Her past medical history was relevant for Crohn’s disease. Ophthalmic examination revealed right 2+ conjunctival injection that blanched with phenylephrine drops. Otherwise, her ophthalmic exam was unremarkable. The patient was started on artificial tears and ibuprofen 200 mg three times daily for one week. After one week all symptoms resolved, and ophthalmic examination was back to baseline.Conclusion: This is the first case in the literature of ophthalmic side effects in a Crohn’s disease patient after the third mRNA COVID-19 booster. Patients with Crohn’s disease may respond differently to booster vaccination. This case report may help healthcare providers when counselling Crohn’s disease patients about future COVID-19 mRNA vaccine side effects.Keywords: episcleritis, Crohn’s disease, case report, COVID-19, vaccine

Purpose This study aimed to investigate the course of uveal manifestations in a cohort of patients who underwent surgery for ulcerative colitis (UC), highlighting the diverse spectrum of associated eye disorders and alerting clinicians of their significance. Patients and methods A retrospective observational study was conducted on 40 UC patients with ocular manifestations who underwent one-stage laparoscopic restorative proctocolectomy according to the European Crohn’s and Colitis Organization (ECCO) guidelines. Ophthalmic examinations were performed preoperatively and postoperatively during the 6-month follow-up period. Anterior uveitis attacks were graded based on the presence of cells or flares, vitreous haze indicates intermediate uveitis while posterior uveitis was indicated by retinitis or choroiditis, or both. Recurrence was a Standardization of Uveitis Nomenclature (SUN) grading system score greater than or equal to 2+ for anterior chamber cells or vitreous haze. Results Postoperatively, uveitis regression was observed in ∼60% of the patients, 25% showed a stationary course, and 15% exhibited progression. After surgery, more patients had lower Standardization of Uveitis Nomenclature grades for anterior chamber cells, flares, and vitreous haze than at baseline. Conclusion Ulcerative colitis can manifest with various ophthalmic manifestations ranging from nonspecific to severe, affecting visual prognosis or remaining asymptomatic. In our study most patients who underwent colonic surgery got benefits in the form of not only decreasing the severity of disease activity but also a decrease in the recurrence rate postsurgical.

Abstract Background Ocular manifestations of granulomatosis with polyangiitis (GPA) have been reported in a limited number of studies and with largely variable frequency. Here we report on the clinical, diagnostic, and therapeutic features of a cohort of 63 GPA patients, with particular regard to 22 of them with ophthalmic involvement (35%). Methods Clinical manifestations, results of immunological findings, histopathological pictures, imaging data, Birmingham Vasculitis Activity Score, therapeutic regimens, and outcomes were retrospectively analyzed. At diagnosis, in addition to a structured clinical assessment, all patients underwent a comprehensive ophthalmologic examination. Results The most frequently involved organs were kidneys, lungs, ear/nose/throat, and eyes. Ocular manifestations were bilateral in 32%. The three most commonly diagnosed ophthalmologic manifestations were scleritis (36%), retro-orbital pseudotumor or orbital mass (23%), and episcleritis (13%). Ocular and systemic involvement were simultaneously present at onset in 41% of the patients; systemic involvement was followed by ocular lesions in 36%; ocular inflammation was followed by systemic manifestations in 18%; and an orbital mass in the absence of systemic disease characterized 5%. Glucocorticoids plus cyclophosphamide and glucocorticoids plus rituximab were the combined therapies most frequently employed during remission induction and remission maintenance, respectively. Persistent ophthalmologic and extra-ocular remissions were achieved in 77 and 64% of the patients, respectively. One to three systemic relapses were diagnosed in 7 patients (31.8%). At the last follow-up, a visual outcome 20/40 or better in 31 (70%) of 44 eyes was determined. Conclusions The eye was involved in over one third of our patients with GPA. Increased awareness, early diagnosis, and multi-specialty collaboration are critical in achieving a favorable outcome of GPA.

In COVID-19, eye damage may develop at any stage of the disease. Viral ribonucleic acid has been found in ocular tissues, but the role of the eye as a route of infection is yet to be substantiated. Ophthalmic manifestations may be a typical feature of COVID-19 infection or they may develop several weeks after recovery. Ophthalmologists should be aware of possible relationships of an ophthalmic pathology with SARS-CoV-2 in order to obtain targeted case history, detect the specific signs, prescribe the necessary tests and thereby reduce the spread of the infection. These relationships are also important for early diagnosis and treatment of complications that threaten the patients’ life and vision. The first part of the review focuses on the possible involvement of the eye in SARS-CoV-2 infection and the spread of infection. Clinical manifestations of the anterior segment damage are considered.

In December 2019, the world faced a new infectious disease, called the novel coronavirus disease 2019 (COVID-19), whose spread has become pandemic. The infection that remains with us to the present day can cause very severe respiratory symptoms up to total lung damage and death, as well as serious systemic manifestations associated with excessive activation of immune mechanisms. Currently, there are many cases of secondary autoimmune processes, often forming full-fledged autoimmune diseases, in people who have had a new coronavirus infection.We present a clinical observation of episcleritis developed on the background of COVID-19, and then an articular syndrome onset that met the classification criteria for rheumatoid arthritis. The unusual debut of the articular syndrome in this patient, the difficulties of early diagnosis of the disease, as well as possible mechanisms of the formation of such associations are discussed.

A 56-year-old man presented at the emergency department with bilateral eye pain, itching and watery discharge for 10 days, fever for seven days, and cough for one day. He had been vaccinated against COVID-19 and had developed ocular symptoms two days after receiving the second dose of the vaccine Sinopharm. Investigations revealed that the nasal PCR was positive for COVID-19. We managed him on the lines of episcleritis and critical COVID-19 pneumonia. The patient later deteriorated and was intubated. He died on the sixth day of his hospitalization as a result of a protracted disease course and ST-segment elevation myocardial infarction (STEMI). We report the development of episcleritis and critical COVID-19 infection after COVID-19 vaccination to emphasize the consideration of antibody-dependent enhancement after vaccination.

Immunoglobulin A nephropathy (IgAN) is a rare but important systemic disease with or without ocular manifestations. We describe 4 cases of IgAN presenting with scleritis and review the various ocular manifestations in patients with IgAN. We found 55 cases with ocular manifestations in patients with prior or newly-diagnosed IgAN described in 38 publications. The most common ocular manifestations of IgAN were episcleritis (23.6%), scleritis (16.4%), hypertensive retinopathy or retinal vasculopathy (20.0%), and uveitis (14.5%). The median age at presentation was 36.5 years, with 54.5% female patients. 61.8% had history of IgAN prior to ocular involvement, while 29.1% had ocular presentations as the first manifestation of IgAN. The majority received systemic corticosteroids and/or immunosuppressants. Additionally, we report 4 women with anterior scleritis and previous diagnosis of IgAN. All 4 were treated with topical and systemic corticosteroids. Three out of 4 patients had no recurrence for at least 1 year since the first presentation. IgAN is a rare but important systemic association to be considered in ocular inflammatory conditions. Timely recognition and comanagement of the disease with nephrologist could reduce disease morbidity. [ABSTRACT FROM AUTHOR]

Background and aims: Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn’s disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. Methods: PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. Results: The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs’ pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs.

Background: Ocular manifestations of granulomatosis with polyangiitis (GPA) have been reported in a limited number of studies and with largely variable frequency. Here we report on the clinical, diagnostic, and therapeutic features of a cohort of 63 GPA patients, with particular regard to 22 of them with ophthalmic involvement (35%). Methods: Clinical manifestations, results of immunological findings, histopathological pictures, imaging data, Birmingham Vasculitis Activity Score, therapeutic regimens, and outcomes were retrospectively analyzed. At diagnosis, in addition to a structured clinical assessment, all patients underwent a comprehensive ophthalmologic examination. Results: The most frequently involved organs were kidneys, lungs, ear/nose/throat, and eyes. Ocular manifestations were bilateral in 32%. The three most commonly diagnosed ophthalmologic manifestations were scleritis (36%), retro-orbital pseudotumor or orbital mass (23%), and episcleritis (13%). Ocular and systemic involvement were simultaneously present at onset in 41% of the patients; systemic involvement was followed by ocular lesions in 36%; ocular inflammation was followed by systemic manifestations in 18%; and an orbital mass in the absence of systemic disease characterized 5%. Glucocorticoids plus cyclophosphamide and glucocorticoids plus rituximab were the combined therapies most frequently employed during remission induction and remission maintenance, respectively. Persistent ophthalmologic and extra-ocular remissions were achieved in 77 and 64% of the patients, respectively. One to three systemic relapses were diagnosed in 7 patients (31.8%). At the last follow-up, a visual outcome 20/40 or better in 31 (70%) of 44 eyes was determined. Conclusions: The eye was involved in over one third of our patients with GPA. Increased awareness, early diagnosis, and multi-specialty collaboration are critical in achieving a favorable outcome of GPA. [ABSTRACT FROM AUTHOR]

AIM: To estimate the magnitude of different ocular manifestation in clinically established herpes zoster ophthalmicus (HZO) patients and assessment of the visual outcome after two months of initial examination. METHODS: An observational prospective study was conducted on 42 clinically diagnosed Tzanck smear positive cases HZO to observe the occurrence and frequency of different ocular manifestation and their visual outcome in 10-month period with 2mo follow up. Full ophthalmological examination using slit lamp, non-contact tonometry, applanation tonometry, direct and indirect ophthalmoscope were performed. RESULTS: Out of 42 patients of HZO, 33 had one or more type of ocular manifestation staring from lid skin involvement to conjunctivitis, keratitis, uveitis, increased intraocular pressure (IOP) and optic neuritis but no retinal manifestation. More number of HZO cases and ocular manifestation were found with advancement of ages. Young HZO patients were more associated with human immunodeficiency virus (HIV) infection and HIV infected people with HZO infection had more ocular manifestation. Male to female ratio was 2:1 among HZO cases but ocular manifestation occurred more among males. Female with advanced age were involved more. Lid involvement (73.81%), conjunctivitis (69.05%), and keratitis (59.52%) were most common ocular manifestation followed by anterior uveitis (30.95%) and episcleritis (11.90%). Ocular hypertension (42.86%) was associated with almost every ocular manifestation. Among the cases of more than 45 years of age, 9.52% patients acquired 6/6 vision compared to 7.14% patients at and below 45 years of age after 8wk of follow up. CONCLUSION: The visual outcomes are poor in HZO with advanced age group. Visual outcome of the affected eyes is poor than unaffected eyes. The loss of vision is mainly due to keratitis, anterior uveitis, posterior uveitis, and optic neuritis.

Introduction: Episcleritis is an acute inflammation of the vascular connective tissue between the conjunctiva and the sclera's surface, which can be found unilateral and bilateral. Tuberculosis (TB) is one of the systemic infectious diseases that cause morbidity in developing countries and can affect the ocular area known as ocular tuberculosis There are still limited cases of ocular tuberculosis studies, specifically tubercular nodular episcleritis in adolescents. This case report aims to expose nodular episcleritis in pediatric tuberculosis patients in Indonesia. Case Presentation: A 16-year-old boy came to the Community Eye Health Hospital East Java with superior bilateral eye redness and pain with normal visual acuity. He underwent advanced anti-tubercular treatment for the last nine months. The best corrected visual acuity (BCVA) of both eyes was 6/6. Slit-lamp biomicroscopy (SLB) examination found the dilation of blood vessels located on the superior episclera accompanied by a firmly bordered, fixed, pink nodule, diameter ± 1.5 mm located at 12 o'clock in bilateral bulbar conjunctiva. Based on anamnesis and physical examination, the diagnosis of nodular episcleritis et causa pulmonary TB was established. Topical corticosteroids and artificial tears eyedrops were given in both eyes for five weeks, and continuing anti-tubercular treatment was performed. Conclusion: It is necessary to investigate the primary cause of episcleritis by eliminating underlying systemic diseases. Herein, we present a rare case of nodular episcleritis in an adolescent with pulmonary tuberculosis who responded very well to anti-tubercular treatment with topical corticosteroid and artificial tears eye drops. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the frequency of the accompanying ocular findings in Rheumatoid Arthritis (RA) patients. Methods: Patients who were consulted at the eye clinic with the diagnosis of rheumatoid arthritis between 01 March 2017 and 28 February 2022 were included in the study. The patients' files were reviewed retrospectively from the hospital information method system, and the demographic characteristics of the patients and eye examination findings related to rheumatoid arthritis were recorded. Results: The records of 23840 patients who were consulted to the eye clinic with the diagnosis of rheumatoid arthritis were reviewed retrospectively, and 2691 patients who were seropositive as a result of the examination were included in the study. Anterior segment biomicroscopy, Schirmer test, tear break-up time (BUT) and fundus examination findings of the patients were evaluated in terms of ophthalmological examination. Of all the patients, 2067 were female and 624 were male. The majority of the patients were between the ages of 41 and 65, with 1374 females and 421 males. While the most common finding of ocular involvement due to rheumatoid arthritis was the lack of tears, known as dry eye, with a rate of 25.97%, episcleritis was found in 4.57% of the patients and scleritis in 1.37%. Conclusions: Rheumatoid Arthritis is a systemic disease that can progress with extra-articular findings and may even appear as its first finding, and may be accompanied by ocular findings at a rate that may impair the quality of life of the patients. A holistic approach in patients with rheumatoid arthritis will positively affect the prognosis of the disease and patients' quality of life in terms of eye health, as is common in chronic diseases in the community. [ABSTRACT FROM AUTHOR]

Purpose: To report the prevalence of scleritis and episcleritis in patients with idiopathic small fiber neuropathy (SFN)., Methods: The Mass General Brigham (MGB) hospital database was queried for patients with SFN, scleritis and episcleritis using diagnostic codes and natural language processing. Electronic medical chart review of patients diagnosed with SFN and episcleritis/scleritis who had at least one ophthalmology visit was conducted. The prevalence of scleritis and episcleritis in patients diagnosed with SFN was compared to those without SFN using logistic regression to adjust for covariates. All statistical analyses were performed in RStudio 4.2.1., Results: From the 2100 SFN patients with an eye exam in the MGB database, 23 patients had episcleritis or scleritis (1.1 %) confirmed by chart review. Ten patients had episcleritis (0.48 %) and thirteen patients had scleritis (0.62 %). Of the episcleritis and scleritis patients, 16 (69.6 %) were women and 7 (30.4 %) were men. Ten (43.5 %) had bilateral ocular disease. The mean age of ocular diagnosis was 51.0 years (range, 22-77 years). Out of the 507,128 controls without SFN in the MGB database, 1481 (0.29 %) had scleritis and 1430 (0.28 %) had episcleritis. Episcleritis and scleritis were more prevalent in patients with SFN than in those without SFN: 0.48 % vs. 0.28 % for episcleritis and 0.62 % vs 0.29 % for scleritis (P values = 0.32 and 0.02, respectively)., Conclusions and Importance: There were higher rates of scleritis in SFN patients compared to non-SFN patients. This potential systemic disease association had not been previously reported., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors have no conflict of interest., (© 2024 The Authors.)

Abstract Background To assess the change in vision-related quality of life and psychosocial well-being of the patients with episcleritis and scleritis patients before and after treatment. Results This one-and-a-half-year prospective study was conducted among 76 eyes of 71 new patients of episcleritis and scleritis. A structured questionnaire was used to assess the visual and to analyze the change in effect size. The male-to-female ratio was 1:1.536. Episcleritis was seen in 41 cases (57.7%) while scleritis was seen in 30 cases (42.3%). Patients with episcleritis had statistically significant improvement in general function score (GF) (p

Cogan's syndrome (CS) is a rare chronic autoimmune vasculitis that can have significant systemic consequences and progress with progressive and inflammatory eye (interstitial keratitis, scleritis, episcleritis, uveitis) and audiovestibular (sensorineural hearing loss, vertigo, tinnitus) involvement. Vasculitis is observed in approximately 15% of patients with CS and may present as aortitis, large-vessel vasculitis (Takayasu-like), moderate arteritis, or other vasculitic syndromes. In this case report, we present the development of severe aortic and mitral valve insufficiency in a patient diagnosed with CS who was admitted to the hospital with episcleritis and sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

A 7-year-old female child was referred to the cornea clinic with a painless, ulcerated, and inflamed nodule near the limbus which did not respond to 1-week antibiotic therapy and worsened on starting topical steroids. Clinical examination showed ulcerative nodular episcleritis and raised a suspicion of herpes simplex virus etiology. The patient responded well and resolved completely on topical antiviral therapy alone.

Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases, which are often accompanied by inflammation of other organs. This article presents modern data on etiology, pathogenesis and clinical course of inflammatory bowel diseases, as well as information on extraintestinal eye manifestations of nonspecific ulcerative colitis and Crohn’s disease. The role of microbiota, genetic factors, immune system defects in pathogenesis of intestinal inflammation and extraintestinal eye manifestations is considered. The possibility the development of ophthalmopathology not only against the background of intestinal inflammation, but also as a consequence of therapeutic and surgical methods of treatment of ulcerative colitis and Crohn’s disease is noted. The peculiarities of the course of episcleritis/scleritis, keratitis, uveitis, chorioretinitis, optical neuritis for patients with inflammatory bowel diseases are considered. The presence of these complications may reflect the activity of the underlying disease, which in some cases requires correction of therapy. Anterior uveitis and episcleritis/scleritis are the most common extraintestinal manifestations of inflammatory bowel disease. Inflammation of tissues of the posterior segment of the eye and optic nerve against the background of ulcerative colitis and Crohn’s disease are less common, but are of clinical importance, as they can catastrophically damage the structures of the eye and, as a consequence, lead to complete blindness. Considering the possibility of mild clinical symptoms and asymptomatic course of inflammation in the eye envelopes, the importance of ophthalmological examination of all patients with ulcerative colitis and Crohn’s disease is emphasized. Aspects of modern therapy of ophthalmopathology and background intestinal inflammation are highlighted. Biological preparations — antagonists of pro-inflammatory cytokines — have been identified as the most promising in the treatment of inflammatory intestinal diseases and extraintestinal manifestations. The important role of proper nutrition and biologically active supplements containing omega-3 fatty acids, vitamin D, microelements, was noted as auxiliary therapy of both intestinal and extraintestinal inflammation.

COVID-19 is a disease caused by a SARS-CoV-2 viral infection, a disease that was first detected in December 2019 in Wuhan, Hubei Province, China. COVID-19, formerly known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease, was officially named COVID-19 by the World Health Organization (WHO) in February 2020. By 25 May 2021, there were 33,579,116 confirmed cases with 599,109 COVID-19 deaths worldwide. The purpose of this review article is to provide an update on what is currently known about COVID-19 ocular symptoms in adults, the elderly, and children in the literature. Finally, this article will review the eye protection precautions that should be implemented in our clinics. To assess the current literature, PubMed was searched from December 2019 to 25 May 2021. Randomized trials, observational studies, case series or case reports, letters of research, and letters to editors were selected for confirmed cases of COVID-19. According to current scientific literature since the outbreak in December 2019, 205 articles have been published. Conjunctivitis, conjunctival hyperemia, and chemosis have been reported in adults with COVID-19. There have been few studies on children and elderly patients, and further research in these age groups is needed. Finally, wearing eye protection when seeing patients on a daily basis during the pandemic is essential. [ABSTRACT FROM AUTHOR]

Inflammatory eye diseases are responsible for a significant proportion of presentations to ophthalmic emergency facilities and knowledge of how to differentiate between broad categories of disease and refer accordingly is important for the practising physician. This review aims to provide an overview of inflammatory eye disease, with a focus on clinical presentation, diagnosis and management. [ABSTRACT FROM AUTHOR]