Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

538 Episcleritis and Scleritis

■Engorgement of superficial and deep episcleral venus plexes

■Tenderness to palpation=scleritis

■Areas of nodule formation and tenderness=nodular scleritis

tests

Laboratory

■Basic blood tests:

➣CBC, ESR, CRP, uric acid, BLN, creatinine

■Basic urine tests:

➣Urinary sediment and urine analysis

■Specific diagnostic tests:

➣ANCA, RFs (IgG, IgA, IgM), ANAs (on RAT liver and Hep2 cells),

hepatitis B antigen, anti Type II collagen antibody, HLA-1327,

FTA-Abs

Imaging

■Chest x-ray and sinus films; B scan ultrasonography

Biopsy

■For histopathology, culture, and PCR studies

differential diagnosis

■Rheumatoid arthritis

■Ankylosing spondylitis

■Wegener granulornatosis

■SLE

■Relapsing polychondritis

■Mixed connective tissue disease

■Polyarteritis nodosa

■Herpes simplex herpes zoster syphilis Hyperuricemia atopy

management

What to Do First

■Assess whether episcleritis or scleritis, whether or not work-up

appropriate, whether or not treatment needed; episcleritis rarely

needs work-up or therapy; scleritis always does

General Measures

■Cold compresses

■Rest