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Histopathological evaluation of scleritis.
Mark Hankins1, Curtis Edward Margo2,3
1Department of Ophthalmology, USF Health Morsani College of Medicine, Tampa, Florida, USA.
Journal of Clinical Pathology
|February 7, 2019
Summary
Scleral inflammation (scleritis) is rare and often linked to autoimmune diseases. Histological evaluation of scleral biopsies aids diagnosis, distinguishing between autoimmune, infectious, and idiopathic causes, though overlap exists.
Area of Science:
- Ophthalmology
- Pathology
- Rheumatology
Background:
- Scleritis, inflammation of the sclera, is an uncommon condition.
- Biopsy is infrequently used for scleritis evaluation, necessitating clear differential diagnoses for histological assessment.
- Scleritis is frequently associated with systemic autoimmune diseases but can also occur as an isolated disorder.
Purpose of the Study:
- To provide a clinical overview of scleritis.
- To describe the context for scleral biopsy in diagnosing scleritis.
- To review the histological patterns and differential diagnoses of scleritis.
Main Methods:
- Review of clinical and histological features of scleritis.
- Analysis of conditions mimicking autoimmune scleritis, including infection and neoplasm.
- Classification of histological patterns based on inflammation, necrosis, vasculitis, granulomas, and fibrosis.
Main Results:
- Histological patterns of scleritis include autoimmune (granulomas, necrosis, vasculitis), infectious (acute inflammation, necrosis), and idiopathic (chronic inflammation, follicles, fibrosis).
- A significant proportion of scleritis cases occur as isolated disorders, not solely linked to systemic autoimmune disease.
- Histopathological overlap between infectious and non-infectious scleritis can complicate classification, especially with small biopsies.
Conclusions:
- Familiarity with the differential diagnosis of scleritis is crucial for accurate histological evaluation.
- The traditional classification system for scleritis may be oversimplified due to overlapping histopathological features.
- Distinguishing between infectious and non-infectious causes of scleritis can be challenging based solely on small biopsy samples.
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