Scleritis

Scleritis
		SYMPTOMS	Significant dull pain \| Tearing \| Photophobia \| Possible pain with eye movement \| Possible vision loss
		SIGNS
			Sectoral or diffuse injection \| Blue-violet scleral hue \| Tearing \| Scleral thinning \| Possible nodule
			Posterior scleritis may show: Optic nerve edema \| Macular edema \| Choroidal folds \| Retinal detachment \| Subretinal granuloma
		WORK-UP	Thorough history \| Slit lamp examination \| Dilated fundus exam \| B-scan for posterior scleritis (check for T-sign) \| Complete blood work-up and physical examination \| A laboratory work-up may be extensive
		TREATMENT
			Oral NSAIDs: Ibuprofen 600 mg tid \| Flurbiprofen 100 mg tid \| Indomethacin 50 mg tid
			Oral steroids: Prednisone 60 mg qd with taper to 20 mg qd
			Topical antibiotic drops may be used to reduce risk of secondary infection (polytrim 1 gtt qid) \| Scleral graft, IV steroids, and/or immunosuppressive agents may be indicated
		FOLLOW-UP	Every 1-3 days during treatment
		ADDITIONAL LAB \| TESTS	B-scan \| Complete lab work-up \| Physical exam
ETIOLOGY	High association (~50%) with a variety of underlying systemic diseases
DIFFERENTIAL DX	Episcleritis \| Vogt-Koyanagi-Harada disease \| Idiopathic orbital inflammatory syndrome
NOTES	Scleromalacia perforans may present with minimal pain \| Differentiate episcleritis from scleritis with the blanch test using 2.5% phenylephrine