Extra-articular manifestations of rheumatic disease - inflammatory eye disease
The three complaints that matter
- *Anatomy dictates the symptoms, and the symptoms dictate the urgency*
- The three complaints that matter in rheumatology practice
| Conjunctivitis | SCLERITIS | ANTERIOR UVEITIS (iritis) | |
|---|---|---|---|
| Pain | Gritty, not truly painful | *SEVERE, BORING, wakes from sleep, radiates to jaw/brow* | Aching, moderate |
| Photophobia | Mild | Yes | Marked |
| Pupil | *Normal* | *Normal* | *CONSTRICTED, irregular (posterior synechiae)* |
| Vision | Normal | May be reduced | Usually reduced |
| Redness | Diffuse, superficial, mobile vessels | Deep, violaceous, does NOT blanch with phenylephrine, vessels immobile | Ciliary flush (perilimbal) |
| Discharge | Yes | No | No |
| Tenderness | No | *Globe tender to palpation* | No |
| Associations | Reactive arthritis, bacterial, viral | RA, SLE, GPA, PAN, relapsing polychondritis, herpes zoster | HLA-B27 disease, sarcoidosis, Behcet, vasculitis, JIA |
- *EPISCLERITIS vs SCLERITIS is the discrimination that matters*
- Episcleritis: mild or no pain, sectoral, BLANCHES with topical phenylephrine 2.5%, benign, self-limiting
- Scleritis: severe pain, does NOT blanch, threatens the globe, signals systemic disease
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