Background/Purpose: Ocular scleral pathology may be associated with autoimmune diseases. Our aim was to assess a) the epidemiological and clinical features and b) the relationship with immune-related diseases.

Methods: Observational study of unselected consecutive patients studied in a single reference University Hospital during the last ten years with: a) diagnosis of episcleritis and b) diagnosis of scleritis (Watson and Hayreh classification system, P. G. Watson, S. S. Hayreh, Br J Ophthalmol. 1976 Mar; 60(3): 163–191).
Patients were studied in a reference multidisciplinary unit (rheumatologist and ophthalmologist). Demographics features, clinical findings, complementary tests and treatment were recorded.

Results: We studied 101 (65 women/38 men) patients /202 eyes with diagnosis of scleral pathology (episcleritis=75; scleritis =26); mean age at diagnosis, 49.0±14.17 years. The mean follow-up was 3.68±5.30 years.Demographic baseline characteristics and clinical manifestations of these patients are shown in TABLE 1.
Diffuse anterior scleritis (n=17; 16.8%) was the most common type of scleritis, followed by nodular. In case of episcleritis, the most common was simple-form (n = 71; 70.3%).
Etiology was as follows: idiopathic (n=59, 58.4%), associated to systemic disease (SD-group) (n=32, 31.7%), and infectious (n=10, 9.9%). In SD-group, the main association was with Crohn’s disease (n=8; 7.9%), rheumatoid arthritis (n=6; 5.9%) and psoriatic arthritis (n=4; 3.9%).
Laboratory tests were also performed in all patients, mainly as screening of systemic diseases. Antinuclear antibodies (ANA) and rheumatoid factor (RF) were positive in 9 patients, followed by HLA-B27 7; 6.9%).
Attending to the treatment, 100% of patients received topical treatment as first-line therapy and 81.2% (n=81) NSAIDs. Another conventional immunosuppressor and biological treatment were required in 27.7% (n=28) and 6.9 (n=7) respectively. The main indication for biological therapy was the presence of concomitant systemic disease.
Some complications were reported, being keratitis (n=6; 5.9%) the most common.

Conclusion: The results obtained are reproducible to those published in international series, except a more frequent of Crohn’s disease and a less frequent of vasculitides. Scleral pathology is a frequent entity and it is necessary to exclude underlying systemic pathology.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ocular-scleral-pathology-and-relationship-with-autoimmune-diseases-study-of-101-patients-from-a-single-universitary-centre/