Uveítis e inflamaciones oculares asociadas a COVID-19

La enfermedad por el coronavirus 2019 (COVID-19) es causada por el coronavirus 2 del síndrome de distrés respiratorio del adulto (SARS-CoV-2). Esta se declaró enfermedad pandémica por la Organización Mundial de la Salud el 11 de enero de 2020. Dentro de sus manifestaciones clínicas oftalmológicas destacan las afecciones en la superficie ocular, de ellas la conjuntivitis folicular, como la de mayor incidencia encontradas en los pacientes infectados. De igual manera, las uveítis, escleritis y epiescleritis han sido reportadas en sus diversas formas de presentación precediendo o acompañando las manifestaciones clínicas generales de la enfermedad, así como en el período pos-COVID-19. El objetivo de esta revisión fue realizar una búsqueda de información para establecer la relación entre uveítis y COVID-19, a pesar de no haber sido reconocida como una de las manifestaciones oculares reportadas con más frecuencia.

Coronavirus 2019 (COVID-19) disease is caused by adult respiratory distress syndrome coronavirus 2 (SARS-CoV-2). It was declared a pandemic disease by the World Health Organization on January 11, 2020. Among its ophthalmologic clinical manifestations, ocular surface disorders stand out, of which follicular conjunctivitis is the most frequent found in infected patients. Similarly, uveitis, scleritis and episcleritis have been reported in their various forms of presentation preceding or accompanying the general clinical manifestations of the disease, as well as in the post-COVID-19 period. The aim of this review was to search for information to establish the relationship between uveitis and COVID-19, although it has not been recognized as one of the most frequently reported ocular manifestations.

Dos manifestaciones oculares de la artritis reumatoide: epiescleritis y escleritis / Two ocular manifestations of Rheumatoid Arthritis: episcleritis and scleritis

La artritis reumatoide es un trastorno inflamatorio sistémico que afecta a las articulaciones, que puede tener varias manifestaciones extraarticulares, incluida la enfermedad ocular inflamatoria. El propósito de este estudio es hacer una descripción general sobre el diagnóstico y el tratamiento de dos manifestaciones oculares de la artritis reumatoide: la epiescleritis y la escleritis, incluida una actualización de las perspectivas del tratamiento. Las manifestaciones oculares, que incluyen epiescleritis, escleritis, queratitis ulcerosa periférica y enfermedad del ojo seco, se pueden encontrar hasta en el 39 por ciento de los pacientes con artritis reumatoide. Si bien no existen consensos ni guías, muchas opciones emitidas desde la práctica reumatológica estarán disponibles para el tratamiento de la escleritis refractaria, una vez descartadas las causas infecciosas, lo que permite un rápido control de la inflamación y evita tanto el daño estructural del ojo como las complicaciones del uso prolongado de esteroides(AU)

Rheumatoid arthritis is a systemic inflammatory disorder that affects the joints, which can have several extra-articular manifestations, including inflammatory eye disease. To provide an overview of the diagnosis and treatment of two ocular manifestations of rheumatoid arthritis: episcleritis and scleritis, including an update on treatment prospects. Ocular manifestations, including episcleritis, scleritis, peripheral ulcerative keratitis, and dry eye disease, can be found in up to 39 percent of rheumatoid arthritis patients. Although there is no consensus or guidelines, many options issued from rheumatology practice will be available for the treatment of refractory scleritis, once the infectious causes have been ruled out, allowing rapid control of inflammation, and avoiding both structural damage to the eye and complications from long-term steroid use(AU)

Bilateral nodular episcleritis due to Varicella-Zoster virus / Episclerite nodular bilateral do vírus varicela-zoster

Abstract The patient is a 10 years-old girl, with chief complaint of recent bilateral red eye and history of chickenpox disease. Examination revealed nodular episcleritis of both eyes. After treatment with topical steroids, the disease was subsided. Varicella-Zoster virus is a rare cause of episcleritis. In this case it seems that the mechanism of involvement is immune-related, rather than direct tissue involvement by virus.

Resumo A paciente é uma menina de 10 anos de idade, com queixa principal de olho vermelho bilateral recente e história de doença da catapora. O exame revelou episclerite nodular de ambos os olhos. Após o tratamento com esteróides tópicos, a doença foi diminuída. O vírus varicela-zoster é uma causa rara de episclerite. Neste caso, parece que o mecanismo de envolvimento é imuno-relacionado, ao invés de envolvimento direto do tecido pelo vírus.

Observation on Xi-Jiao Di-Huang Decoction on Episcleritis Treatment Effect / 世界科学技术-中医药现代化

This study was aimed to observe the clinical efficacy of Xi-Jiao Di-Huang (XJDH) decoction in the treatment of episcleritis and to provide references for its clinical treatment.A total of 48 episcleritis cases from January to December 2015 were randomly divided into two groups,with 26 cases in the observation group and 22 cases in the control group.The same conventional drug therapy was given to both groups.XJDH decoction was also given to the observation group.Clinical efficacy and recurrence rate of both groups were compared.The results showed that the total effective rate of the observation group was 92.30％,which was obviously better than 72.72％ in the control group,with statistical significance (P ＜ 0.05).The recurrence rate of the observation group was 26.90％,which was obviously better than 40.90％ in the control group,with statistical significance (P ＜ 0.05).It was concluded that XJDH decoction combined with modern medicine treatment in the treatment of episcleritis achieved better clinical curative effect with lower recurrence rate.It provided positive guidance in the clinical treatment of episcleritis.

Escleritis posterior: a propósito de un caso / Posterior scleritis: a propos of a case

Las enfermedades inflamatorias de la esclera son infrecuentes. Involucran tanto la esclera como la epiesclera y se caracterizan por su cronicidad, dolor y por ser una causa potencial de ceguera. Su asociación con enfermedades sistémicas, frecuentemente de causa autoinmune, y la aparición de graves complicaciones oculares, conllevan una terapia sistémica agresiva con antinflamatorios no esteroideos, corticoesteroides y agentes inmunosupresores, los cuales se pueden utilizar solos o combinados. Presentamos el caso de un paciente masculino de 37 años de edad quien acudió al Cuerpo de Guardia por dolor ocular intenso, asociado a ojo rojo, disminución de la agudeza visual y cifras elevadas de tensión ocular del ojo derecho, a quien le fue diagnosticada una escleritis posterior.

The inflammatory diseases of the sclera are uncommon. They involve both the sclera and the episclera and are characterized by chronic nature, pain and potential cause of blindness. Their association with systemic diseases, frequently autoimmune ones, and the occurrence of serious ocular complications lead to applying aggressive systemic therapy with non-steroid antinflammatory drugs, corticosteroids and immunosuppressive agents, which can be administered alone or combined. This is a 37 years-old patient who went to the emergency service because he suffered intense ocular pain associated to red eyes, reduction of visual acuity and high ocular pressure values in his right eye. He was finally diagnosed with posterior scleritis.

A Case of Episcleritis as a Manifestation of Neurosyphilis

PURPOSE: To report a rare case of episcleritis as the only manifestation of neurosyphilis. CASE SUMMARY: A 40-year-old female was referred to the outpatient clinic because of right episcleritis that was unchanged during the month of treatment. Her headache persisted, and slit lamp examination showed tortuous congestion of engorged episcleral vessels with swelling in the superior-temporal region of the right eye, but fundus and radiological studies showed normal findings. Serological tests were reactive for venereal disease research laboratory test, treponema pallidum hemagglutination assay test, and fluorescent treponemal antibody absorption test. Under the suspicion of persistent syphilis infection, cerebrospinal fluid examination was performed, and the diagnosis of neurosyphilis with episcleritis was diagnosed. Treatment consisted of intravenous injections of 5 million IU penicillin G potassium every 4 hours for 14 days. The ocular inflammation resolved within the first week of treatment and did not recur. CONCLUSIONS: We report a case of intractable episcleritis that required examination for syphilitic infection using serological and CSF tests, and the appropriate antimicrobial therapy for syphilis with follow-up examinations.

Tubercular nodular episcleritis.

A 12-year-old male child suffering from pain, redness, blurring and watering of right eye since six months was diagnosed as suffering from nodular episcleritis probably tuberculosis. Diagnosis was supported by the additional finding of enlarged cervical lymph node found on aspiration cytology. Complete resolution occurred after anti-tuberculosis therapy.

Serologic Test and Therapeutic Drugs of Episcleritis and Scleritis

PURPOSE: To evaluate serologic tests and therapeutic drugs of the patients with episcleritis and scleritis. METHODS: Retrospective chart review was performed for above patients that had been followed from 1986. 8. 8 to 2001. 6. 4. RESULTS: Of a total of 26 patients, 5 patients (38.5%) with episcleritis and 7 patients (53.8%) with scleritis showed seropositivity. Rheumatoid factor (RF) (26.1%) and antinuclear antibody (ANA) (26.1%) were most commonly positive. Eleven patients (84.6%) with episcleritis group were given topical steroid, 3 patients (23.1%) were treated with systemic drugs due to ocular lesions, and 6 patients (46.2%) with systemic drug for underlying systemic diseases. In scleritis group, 11 patients (84.6%) were treated with topical steroid, 2 patients (15.4%) with systemic drugs for ocular lesions, and 7 patients (53.8%) with systemic drug for underlying systemic diseases. An average period of treatment time was 6.4 weeks in episcleritis and 11.1 weeks in scleritis. CONCLUSIONS: Serologic tests help document the underlying disorders in patients with scleritis and in those with persistent or often recurred episcleritis. Also treatment of episcleritis and scleritis requires understanding possible effects of systemic drugs adminstered for underlying disorder on ocular lesion, and requires cooperation with internists and rheumatolgists.

A Case of Episcleritis with Relapsing Polychondritis

PURPOSE: Relapsing polychondritis is a progressive inflammatory disorder of unknown cause affecting predominantly the cartilage of the ears, nose, and tracheobronchial tree as well as internal structures of the eyes and nose. Episcleritis is the most common ocular manifestation. We experienced a case of relapsing polychondritis with episcleritis and it's treatment. Therefore, we report this case with literature review. METHODS: Seventy-year-old woman presented with ocular pain and redness in right eye which had developed one week before. She had bilateral auricular chondritis, vertigo, saddle nose deformity, polyarthritis and respiratory difficulty. Relapsing polychondritis was diagnosed by typical clinical features. RESULTS: The patient was started on systemic steroid therapy and 0.1% dexamethasone in the right eye four times daily as well as oral ibuprofen 600 mg four times daily, which were slowly tapered off over the next four weeks with the resolution of the episcleritis.

Clinical Features of the Episcleritis and the Scleritis

PURPOSE: To evaluate the clinical features of the patients with episcleritis and scleritis. METHODS: Retrospective chart review was performed for above patients that had been followed from 1986. 8. 8 to 2001. 6. 4. RESULTS: The number of patients with episcleritis was 17 (49%) and that of scleritis was 18 (51%). Ocular complication occurred in 59% of patients with episcleritis and 72% of patients with scleritis. Keratitis was the most common ocular complication. No patient with episcleritis had a decrease in visual acuity, whereas 33% of patients with scleritis did. Systemic diseases were found in 69% of episcleritis whereas 77% of patients with scleritis associated with systemic diseases. Rheumatoid arthritis was the most common one in both groups of patients. CONCLUSIONS: Ocular complications, systemic diseases, and decrease in visual acuity are associated more of commonly with scleritis than episcleritis. When scleritis is suspected, careful examinations for associated ocular complications should be performed and be followed with history taking and evaluation for associated systemic disease.