Scleritis, clinical features, etiological diagnosis and treatment : a review of 32 cases

Purpose To evaluate the various clinical presentations, etiological diagnosis and prognosis of patients with scleritis at a tertiary care eye center. Methods Retrospective, monocentric and analytical study on a series of 32 patients with scleritis seen in the departments of Ophthalmology and Internal Medicine at Croix-Rousse University Hospital, Lyon, France from 2004 through 2011. Results The mean age of patients with scleritis was 46.8 years (range 22-77years). Nineteen of the patients were women and 13 were men. Twenty-six patients (81%) had anterior scleritis (15 nodular, 8 diffuse and 3 necrotizing), six (19%) had posterior scleritis. Unilateral inflammation was present in 24 patients (75%). Twelve of the 32 patients (37.5%) had a systemic disease : Wegener's granulomatosis (n = 3),Behcet's disease (n = 2), unspecified inflammatory arthritis (n = 2), psoriatic arthritis (n = 1),ankylosing spondylitis (n = 1), sarcoidosis (n = 1), Cogan's syndrome (n = 1), ulcerative colitis (n = 1). Six patients (18.8%) were suspected of having infectious disease with herpes : clinical context and positive treatment response with oral valacyclovir. Systemic agents and topical agents were required in 28 patients (87.5%). The first line therapy was mainly oral non steroidal anti-inflammatory drugs in 15 patients (47%) and oral corticosteroids in 8 (25%). Immunosuppressive drugs were required in 6 patients, 4 with systemic disease. The mean follow-up was 16.3 months. Conclusion The number of systemic disease in our series is similar to the main series in the literature. Treatment with valacyclovir might be effective in patients with suspected herpes simplex scleritis.