The Sclera pp 59-94 | Cite as

Diagnostic Approach to Episcleritis and Scleritis

  • C. Stephen Foster
  • Maite Sainz de la Maza


Scleral inflammation gives rise to a spectrum of conditions, ranging from a trivial, self-limiting episode to a vision-threatening necrotizing process. Clinical differentiation of these conditions is important because they follow different courses and have different prognostic significance. Several classifications have been proposed on the basis of clinical, clinicopathological, and etiological aspects. The most frequently used is based on the anatomical site of the inflammation and on the clinical appearance of the disease at presentation (Table 3.1). This classification, proposed by Watson and Hayreh,l has proved to be satisfactory because it enables one to assign most patients to a particular category and subcategory at the initial clinical examination, with almost no changes over the course of the disease. Two main groups can be differentiated: episcleritis and scleritis (Figs. 3.1 and 3.2; see color insert). Episcleritis is a benign recurrent disease with little systemic disease association, whereas scleritis not only can cause great pain, loss of vision, and in some cases destruction of the eye, but also may portend an underlying, potentially lethal systemic disease (Table 3.2). There are distinct clinical patterns that help to distinguish episcleritis from scleritis. There are also distinguishing features that may help uncover the underlying systemic diseases. Early detection and characterization of the scleral and systemic disease leads to early treatment, which can improve both ocular and systemic prognoses. This chapter provides specific guidelines for a diagnostic approach in patients with episcleritis and scleritis.


Systemic Lupus Erythematosus Herpes Zoster Giant Cell Arteritis Relapse Polychondritis Scleral Tissue 
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Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • C. Stephen Foster
    • 1
  • Maite Sainz de la Maza
    • 2
  1. 1.Harvard Medical School, Immunology and Uveitis ServiceMassachusetts Eye and Ear InfirmaryBostonUSA
  2. 2.Central University of BarcelonaBarcelonaSpain

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