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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
Ophthalmological manifestations are common in syphilis. Common eye complications are scleritis, panuveitis, dacyroadenitis, chorioretinitis, vitritis, keratitis, oculomotor palsies and optic neuropathy.33 Ocular involvement is generally part of central nervous system involvement. The optic nerve in syphilis is involved in secondary or tertiary stages.2 The syphilitic optic neuropathy can be unilateral or bilateral, often without involvement of the anterior segment.2 Syphilitic optic neuropathy presents either as papillitis, chiasmal syndrome, neuroretinitis, optic nerve gumma or optic nerve perineuritis.34–36 There can also be cortical vision loss. Appropriate tests for the diagnosis of ocular syphilis are fluorescent treponemal antibody absorption assay or the Treponema pallidum particle agglutination assay. The non-treponemal tests, like venereal disease research laboratory (VDRL), fail to diagnose late stages of syphilis.37 Intravenous penicillin G is the drug of choice for all forms of syphilis. Intramuscular benzathine penicillin along with oral probenecid is another option. Newer treatment options include drugs with good cerebrospinal fluid penetration, like ceftriaxone and azithromycin.38
Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Nasal disease (Illus. WEGENER'S GRANULOMA, Vasculitis Pt. 21d) produces discharge, ulceration and severe crusting of the nares. Considerable bony necrosis may also occur, which may lead to collapse of the nasal bones mimicking malignant granuloma. The patients may also have oral and pharyngeal ulceration, and these may be the presenting feature. Ear disease is usually otitis media, and this may lead to deafness. Ocular complications include conjunctivitis, scleritis, uveitis and corneal ulceration. General symptoms such as fever, malaise and weight loss may be severe.
Ophthalmic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
The eye is locally red in episcleritis, and diffusely red and tender with reflex tearing, but minimal discharge in scleritis. Progression to scleral thickening and discolouration then eyeball perforation may occur in scleritis.
Etiology, Pathogens, Clinical Features and Treatment of Bacterial Scleritis
Published in Seminars in Ophthalmology, 2023
Xiangtong Chen, Xueman Lv, Li Yang, Feng Bai, Xiaoli Liu
Bacterial scleritis mainly occurs in the middle-aged patients, and there is no gender difference. Pseudomonas aeruginosa is the most common pathogens in developed countries. However, Mycobacterium tuberculosis are more common in developing countries, especially in India. Eye surgery and trauma are the possible causes of bacterial infection. In addition, wearing contact lenses was also a possible cause of bacterial scleritis. The main symptoms of bacterial scleritis are red and painful eyes. The patient’s visual acuity decreased significantly. Patients with Pseudomonas aeruginosa or Nocardia infection usually presented with a necrotizing scleritis, while Tuberculous scleritis usually presents as anterior nodular scleritis. Bacterial culture was an effective method of diagnosis. Most bacterial scleritis cases require both aggressive medical and surgical treatment, and the drug choice must be based on antibiotic susceptibility testing.
Clinical Profile of Scleritis Presenting for the First Time in the Elderly
Published in Ocular Immunology and Inflammation, 2023
Kowsigan Magesan, Janani Surya, Sudharshan Sridharan, Vineeta Nair, Mamta Agarwal, Amala Elizabeth Agarwal, Jyotirmay Biswas, Parthopratim Dutta Majumder
The index study is a hospital-based retrospective analysis of all patients ≥60 years who developed scleritis for the first time and managed at a tertiary eye center between January 2008 and December 2018. The study was approved by the institutional review board of the hospital and adhered to the tenets of the declaration of Helsinki. Scleritis was diagnosed by clinical examination based on characteristic ophthalmic symptoms and signs like excruciating pain with congestion of the deeper episcleral vessels, scleral edema, and congestion, scleral nodule, evidence of scleral necrosis, with scleral thinning or defect. Posterior scleritis was diagnosed by fundus examination and confirmed with B-scan ultrasonography. Scleritis was further categorized into anterior diffuse, nodular, necrotizing, and posterior scleritis. Patients who developed scleritis before 60 years of age were excluded from the analysis. Patients with insufficient documentation or follow-up of less than 6 months were excluded from the study. The index study excluded patients with microbiologically proven infective scleritis (with the specimens obtained by scleral scraping), prior history of intraocular inflammation, surgically induced necrotizing scleritis, history of immunosuppression, chemotherapy and neoplasm. The study also excluded the patients with viral scleritis and cases of scleral inflammation that required or were treated with local or topical antimicrobial agents empirically or presumptively.
Clinical Profile, Systemic Association, Treatment and Visual Outcome of Patients with Scleritis in an Eye Care Center in Mexico City
Published in Ocular Immunology and Inflammation, 2023
Natalia Andrea Suarez Avellaneda, Yasha Bobadilla Marroquin, Carlos Emiliano Rodriguez Lopez, Maria Fernanda Loya Carrera, Miguel Pedroza-Seres
Scleritis can be accompanied by other manifestations of ocular inflammation, the most common was anterior uveitis (47.5%), in second place was PUK (14.1%), this one mainly accompanying diffuse and anterior necrotizing scleritis. The complications of scleritis that can be sight threatening are scleral thinning, corneal ulceration, keratitis, cataract, glaucoma, uveitis, serous retinal detachment, choroidal effusion, optic nerve edema and endophthalmitis.2 In our study, the most important complications were cataract (12.3%) and ocular hypertension/secondary glaucoma (4.9%), this prevalence was lower compared to percentages described in other studies, where anterior uveitis was 26.4%, 40.4% and ocular hypertension/secondary glaucoma was 14.2%, 28.8% respectively.2,15