Características clínicas y respuestas al tratamiento sistémico de la epiescleritis y escleritis primarias y secundarias, refractarias al tratamiento local / Clinical feactures and response to systemic treatment in episcleritis and scleritis resistent to local treatment

Background: Scleritis and episcleritis may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. Aim: To evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis. Patients and methods: Forty six patients with refractory scleritis and episcleritis were studied and treated during the period 1991 to 1998. Results: Necrotizing type was the most common and severe category in the scleritis group of patients. A decrease in vision occurred in 58.3 percent of patients with scleritis v/s a 23.5 percent of patients with epiescleritis (p<0,05). Uveitis was present in 35.4 percent of patients with scleritis and scleromalacia was present in 33.3 percent (p<0,05). A specific disease association was uncovered in 51 percent of scleritis and in 38 percent of episcleritis patients. Rheumatoid arthritis, primary systemic vasculitic disease and Sjsgren syndrome with vasculitis were the most common associated systemic diseases. Three patients with scleritis had tuberculosis. Conclusions: 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. A meticulous approach for the detection of a specific associated disease must be undertaken. Scleritis associated with vasculitis has a worse ocular prognosis than other non infectious diseases. Cyclophosphamide is the most effective inmunosuppresive treatment to control severe ocular involvement