Sainz de la Maza M, Jabbur N S, Foster C S
Ocular Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
Ophthalmology. 1994 Feb;101(2):389-96. doi: 10.1016/s0161-6420(94)31325-x.
Inflammation of the wall of the eyeball may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. This study was undertaken to evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis.
Ocular complications and specific disease association were evaluated in 266 patients (358 eyes) with different types of scleritis (diffuse, nodular, necrotizing, scleromalacia perforans, and posterior) and episcleritis (simple and nodular).
In patients with scleritis, decrease in vision occurred in 37%, anterior uveitis was present in 42%, peripheral ulcerative keratitis developed in 14%, glaucoma occurred in 13%, cataract formed in 17%, fundus abnormalities appeared in 6%, and specific disease association was uncovered in 57%. These findings were most commonly associated with necrotizing scleritis. In patients with episcleritis, decreased vision occurred in 2%, anterior uveitis was present in 11%, glaucoma developed in 4%, cataract formed in 2%, and specific disease association was uncovered in 32%. These findings were similar in simple and nodular episcleritis.
In a patient with scleritis, examination of visual acuity, anterior uvea, cornea, lens, intraocular pressure, and fundus must be performed in every follow-up visit, and a meticulous approach for detection of a specific associated disease must be undertaken since the first visit. Scleritis is more severe than episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information.
眼球壁炎症可能蔓延至相邻眼组织，导致失明，还可能与潜在致命的全身性疾病相关。本研究旨在评估不同类型巩膜炎和表层巩膜炎的眼部并发症及全身性疾病关联。
对266例患者（358只眼）进行评估，这些患者患有不同类型的巩膜炎（弥漫性、结节性、坏死性、穿孔性巩膜软化症和后部巩膜炎）和表层巩膜炎（单纯性和结节性），评估其眼部并发症及特定疾病关联。
巩膜炎患者中，37%出现视力下降，42%存在前葡萄膜炎，14%发生周边溃疡性角膜炎，13%出现青光眼，17%形成白内障，6%出现眼底异常，57%发现特定疾病关联。这些发现最常与坏死性巩膜炎相关。表层巩膜炎患者中，2%出现视力下降，11%存在前葡萄膜炎，4%发生青光眼，2%形成白内障，32%发现特定疾病关联。单纯性和结节性表层巩膜炎的这些发现相似。
对于巩膜炎患者，每次随访均须检查视力、前葡萄膜、角膜、晶状体、眼压和眼底，自首次就诊起就必须采取细致方法检测特定相关疾病。巩膜炎比表层巩膜炎更严重，坏死性巩膜炎是最严重的巩膜炎类型。巩膜炎和表层巩膜炎的分类提供了有价值的预后信息。
