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Scleritis: a clinicopathologic study of 55 cases
W P Riono1, A A Hidayat, N A Rao
1A.R. Irvine Ocular Pathology Laboratories of the Doheny Eye Institute and the Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles 90033, USA.
Ophthalmology
|July 16, 1999
Summary
Histopathologic features help differentiate necrotizing scleritis causes. Rheumatoid scleritis and other autoimmune-related cases show distinct patterns from idiopathic or infectious scleritis.
Area of Science:
- Ophthalmology
- Pathology
- Rheumatology
Background:
- Scleritis is a serious inflammatory condition of the sclera.
- Necrotizing scleritis, a severe form, can lead to vision loss.
- Understanding the histopathologic features associated with different causes is crucial for diagnosis and management.
Purpose of the Study:
- To evaluate the histopathologic features of various causes of scleritis.
- To correlate clinicopathologic findings with underlying diseases.
- To differentiate between autoimmune-mediated, infectious, and idiopathic scleritis based on histology.
Main Methods:
- Retrospective observational case series of 55 patients with clinically diagnosed necrotizing scleritis.
- Histopathologic analysis of enucleated globes or biopsy specimens.
- Classification into four morphologic groups based on scleral inflammation patterns.
- Review of clinical charts for associated systemic diseases.
Main Results:
- Four morphologic groups were identified: zonal necrotizing granulomatous inflammation (25.4%), nonzonal diffuse inflammation (34.5%), necrotizing inflammation with microabscesses (38.2%), and sarcoidal granulomatous inflammation (1.8%).
- Systemic autoimmune diseases, including rheumatoid arthritis, were associated with the first group.
- Infectious agents were identified in a subset of the microabscess group.
- The sarcoidal group represented a single case of sarcoidosis.
Conclusions:
- Histologic features can differentiate rheumatoid scleritis and other systemic autoimmune-mediated necrotizing scleritis from idiopathic or infectious causes.
- Histopathologic findings in rheumatoid scleritis are similar to those in scleritis associated with other systemic autoimmune diseases.
- Histopathology provides valuable insights into the etiology of necrotizing scleritis.