SCLERITE (scieritis; Greek skleros firm, elastic + - itis) — an inflammation of a sclera.
S.'s Aetiology is extremely various and in many cases it is not possible to establish it. Most often there are autoimmune S. at collagenic diseases (see). S.'s development is possible at inf. diseases as a result of toksiko-allergic reactions (tubercular and syphilitic episclerites) or a hematogenous drift of bacteria, viruses in a sclera (e.g., metastatic granulematozny tubercular and syphilitic deep S.). In rare instances at sepsis, existence in an organism of the centers of an infection (is more often than a staphylococcal etiology) — a furunculosis, osteomyelitis, a paraproctitis, a felon, tonsillitis, periodontosis, etc. — there can be a metastatic purulent deep sclerite.
Most often deep S. arises for the second time at inflammatory diseases of a choroid of an eye. S.'s development at germination of a tumor of a choroid of an eye in a sclera is possible. S. developing against the background of disbolism (e.g. is described, at gout).
Depending on morfol. structures of cellular inflammatory infiltrate allocate granulematozny and purulent Pages. At granulematozny superficial and deep S. cellular infiltrate consists preferential of lymphocytes with impurity of epithelial and colossal cells, often spreads on the course of ciliary arteries to glubzhelezhashchy covers of an eye. At tubercular S. infiltrate in a sclera has the structure typical for tuberculomas (see). At purulent S. infiltrate consists preferential of polinuklear-ny leukocytes.
At an easy current of S. infiltrate resolves. Reparative processes are carried out by hl. obr. at the expense of fabrics rich with vessels — conjunctivas, episcleras (an episkleralny plate, T.), choroid of an eye. At massive infiltration the necrosis of cellular elements and collagenic fibers of a sclera (fibrinoid dystrophy) is observed. In the subsequent cicatricial fabric develops, there occurs thinning and an ectasia of a sclera.
A clinical picture
Depending on depth of defeat scleras (see) process can be superficial (episcleritis) and deep. On topography allocate front and back S., developing respectively in zones, blood supply to-rykh is carried out by front or back ciliary arteries. On a wedge, to a current distinguish acute and chronic Page. Features of a structure of a sclera (weak vascularization) define a peculiar course of inflammatory processes. Exudative and proliferative reactions are expressed poorly, as a rule, have hron. current. The acute course of inflammatory process is observed at purulent
S. Klien, superficial and deep S.' differentiation is quite often complicated and the hl is based. obr. on definition of extent of involvement in process of a choroid of an eye and a cornea, existence of the centers of thinning of a sclera and some other a wedge, symptoms.
The episcleritis is characterized diffusion or a nodule of an episclera — a diffusion or nodular episcleritis (fig). Develops near a limb more often, at the same time the superficial episkleralny and conjunctival injection, a small swelling appears. At a palpation morbidity of the struck part of an eyeglobe is noted, sometimes there are small independent pains. Patients complain on photophobia (see), dacryagogue. A current of an episcleritis chronic, a recurrence and remissions alternate for a row of years. The inflammatory center at a nodular episcleritis after a rassasyvaniye can arise on the new place, gradually moving around a limb (the migrating episcleritis). Quite often both eyes are surprised.
Deep sclerite. Distinguish granulematozny and purulent deep Pages. At granulematozny deep S. in deep layers of a sclera there are one or several infiltrates, there is a deep scleral injection having a violet shade. The patient complains of severe pains in an eyeglobe, sharply expressed photophobia, dacryagogue. Both eyes can be involved in process. The disease proceeds chronically with a recurrence, can take more and more extensive zones of a sclera, extend deep into. At defeat of a scleral part of a shlemmov of the channel (a venous sine of a sclera, T.) — main outflow tract of intraocular liquid (watery moisture, T.) — intraocular pressure increases, secondary develops glaucoma (see). In hard cases owing to ontogenetic and anatomic communication between a sclera, a choroid of an eye and a cornea the iris can be involved in inflammatory process (iridosklerit), a cornea (keratoscleritis). At the combined defeats of a sclera, cornea, iris, ciliary body arises keratosklerouveit. At widespread defeats of a sclera and choroid of an eye unions of an iris with the capsule of a crystalline lens (back synechias), unions and for a rashcheniye of a pupil are formed that can lead to increase in intraocular pressure, i.e. development of secondary glaucoma, (see).
Distribution of an inflammation on an idiovascular cover (horioideyu) can lead also to development of secondary amotio of a retina (see). During the involvement in process of a tenonovy fascia of an eyeglobe (a vagina of an eyeglobe, T.) arises sklerotenonit. Inflammatory infiltrate is located at the same time in a back piece of a sclera (behind an equator of eyeball). This department of a sclera is unavailable to direct observation, its defeat is shown by sharp pains (spontaneous and at the movements of an eyeglobe), restriction of mobility of an eyeglobe, hypostasis a century, a lung ptosis (see), exophthalmos (see), hyperemia and chemosis, etc.
Purulent S. (abscess of a sclera) is characterized by an acute current. In a sclera in the field of an exit of front or back ciliary arteries the inflammatory center, sharply painful limited dark red with a yellowish shade, appears. Further the center is softened and opened. On site abscess the hem, an ectasia of a sclera are formed; in rare instances abscess can resolve. During the involvement in process of an iris the iritis develops (see. Iridocyclitis ), followed hypopyon (see). In hard cases development is possible entophthalmia (see), panophthalmia (see), perforation of an eyeglobe.
«Jellylike», or «fleshy», the sclerite (the etiology to-rogo is not established) is shown by a heavy diffusion inflammation of a sclera around a cornea. The sclera has red-brown color, a peculiar gelatinous appearance. The conjunctiva over infiltrate is sharply edematous, raised. Process is followed by severe pains. Often develop uveitis (see), keratitis (see). The course of a disease heavy, death of an eye is possible.
the Diagnosis establish on the basis a wedge, researches — a method of side lighting, biomicroscopy of an eye (see), oftalmoskopiya (see). Conduct a cytologic and virologic research of scraping of a conjunctiva in the field of infiltrate of a sclera, and at purulent sclerites — bacterial. research of punctate of abscess. Apply an immunological method of focal tests to confirmation of the toksiko-allergic nature of S. — studying of reactions from an eye (focal reactions) to cutaneous, intradermal or hypodermic administration of offending allergen: tuberculine, toksoplazmin, streptococcal or staphylococcal allergen, etc.
At S. is shown the general and topical treatment. Its character depends on an etiology of a disease (if the etiology is not established, carry out the antiinflammatory, desensibilizing treatment). Use antibacterial drugs (generally at infectious S.), corticosteroids, immunodepressants, antihistamines, salicylates, cytostatics (it is preferential at autoimmune S.). An effective method of treatment of current-siko-allergic S. is specific desensitization (see), to-ruyu carry out by introduction to the patient of the corresponding allergens (naira., tuberculine, streptococcal allergen) vnutrikozhno or by means of an electrophoresis. At S. which developed against the background of frustration of a metabolism (e.g., at gout), correction of exchange disturbances is necessary.
Locally at S. inf. etiologies appoint antibiotics, sulfanamide drugs in the form of instillations, a subconjunctiva of l of ny injections, and also by means of an electrophoresis. At S. of autoimmune and toksiko-allergic genesis the instillation in a conjunctival sac of 0,5% of solution of a cortisone, subconjunctival injections of Dexasonum (dexamethasone) is shown. During the involvement in process of an iris appoint instillations of 0,5% of solution of Atropini sulfas, 0,25% of solution of Scopolaminum of hydrobromide.
Physiotherapeutic methods of treatment were widely adopted: UVCh-therapy, electro-and fonoforez pharmaceuticals, magnetotherapy, amplipulsetherapy (use of the harmonic modulated currents).
At purulent S. opening of abscess of a sclera is shown, at a necrosis and perforation of a sclera apply a scleroplasty.
The forecast and Prevention
At episclerites and limited deep S. sight does not suffer, the forecast favorable. At heavy deep S. there is a scarring of a sclera, its thinning, there are ectasia leading to development of an astigmatism (see. Astigmatism of an eye ) and to decrease in visual acuity. Involvement in process of a choroid of an eye and a cornea at heavy, recurrent sclerites can lead to decrease in visual acuity. The entophthalmia and a panophthalmia complicating purulent S.'s current in some cases come to an end with functional and anatomic death of an eye.
Prevention consists in sanitation of the centers of an infection in an organism, timely complex treatment of infectious and autoimmune diseases, correction of disbolism.
Bibliography: Eye diseases, under the editorship of T. I. Broshevsky of A. A. Bochkaryova's pi, page 223, M., 1983; The Multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 2, page 287, M., 1960; Samoylov A. Ya., Yuzefova F. I. and Azarova N. S. Tubercular diseases of eyes, page 134, M., 1963; In ep-s about n W. E. and. lake of Posterior scieritis, A cause of diagnostic confusion, Arch. Oph-thal., v. 97, p. 1482, 1979; H e m b-of y R. M. a. o. Experimental model for scieritis, ibid., p. 1337; S ten son S., Brookner A. Rosenthal S. Bilateral endogenous necrotizing scieritis due to Aspergillus oryzae, Ann. Ophthal., v. 14, p. 67, 1982; System of ophthalmology, ed._ by W. Duke-Elder, v. 8, p. 1003, L., 1965.
O. B. Chentsova.