Masquerade syndrome in ocular surface squamous neoplasia.

The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

The clinical and pathogenic spectrum of surgically-induced scleral necrosis: A review.

The onset of scleral necrosis after ocular surgery may have catastrophic ocular and systemic consequences. The two most frequent surgeries causing surgically-induced scleral necrosis (SISN) are pterygium excision and cataract extraction. Several pathogenic mechanisms are involved in surgically induced scleral necrosis. All of them are poorly understood. Ocular trauma increasing lytic action of collagenases with subsequent collagen degradation, vascular disruption leading to local ischemia, and immune complex deposition activating the complement system represents some of the events that lead to scleral necrosis. The complex cascade of events involving different pathogenic mechanisms and the patient's abnormal immune response frequently leads to delayed wound healing that predisposes the development of scleral necrosis. The management of SISN ranges from short-term systemic anti-inflammatory drugs to aggressive immunosuppressive therapy and surgical repair. Therefore, before performing any ocular surgery involving the sclera, a thorough ophthalmic and systemic evaluation must be done to identify high-risk patients that may develop SISN.

Ultrasound diagnosis and monitoring of canine scleritis / Diagnóstico ultrassonográfico e monitoramento da esclerite em cães

Scleritis is a severe painful inflammatory and vision-threatening disease. The purpose of this paper is to describe two cases of scleritis in dogs treated with immunosuppressors and monitored by ocular ultrasound. In both cases the ocular wall presented marked thickening and the ultrasonic exams were repeated for weeks showing progressive improvement allowing adjusting the dosage of the medications. In conclusion, ocular ultrasound is a useful tool in the diagnosis and management of scleritis in dogs.(AU)

A esclerite é uma doença inflamatória extremamente dolorosa e pode afetar seriamente a visão. O presente trabalho descreve dois casos de esclerite em cães tratados com imunossupressores e monitorados pela ultrassonografia ocular. Em ambos os casos, a parede ocular apresentava acentuado espessamento e as avaliações ultrassonográficas foram repetidas por semanas, revelando melhoria progressiva e permitindo ajustes na dosagem das medicações. Em conclusão, a ultrassonografia ocular é um instrumento útil no diagnóstico e tratamento da esclerite em cães.(AU)

Ultrasound diagnosis and monitoring of canine scleritis / Diagnóstico ultrassonográfico e monitoramento da esclerite em cães

Scleritis is a severe painful inflammatory and vision-threatening disease. The purpose of this paper is to describe two cases of scleritis in dogs treated with immunosuppressors and monitored by ocular ultrasound. In both cases the ocular wall presented marked thickening and the ultrasonic exams were repeated for weeks showing progressive improvement allowing adjusting the dosage of the medications. In conclusion, ocular ultrasound is a useful tool in the diagnosis and management of scleritis in dogs.

A esclerite é uma doença inflamatória extremamente dolorosa e pode afetar seriamente a visão. O presente trabalho descreve dois casos de esclerite em cães tratados com imunossupressores e monitorados pela ultrassonografia ocular. Em ambos os casos, a parede ocular apresentava acentuado espessamento e as avaliações ultrassonográficas foram repetidas por semanas, revelando melhoria progressiva e permitindo ajustes na dosagem das medicações. Em conclusão, a ultrassonografia ocular é um instrumento útil no diagnóstico e tratamento da esclerite em cães.

Necrotizing nocardial scleritis after combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation: a case report and review of the literature.

We report the history and clinical presentation of an 88-year-old female with Fuchs dystrophy who developed an acute anterior necrotizing scleritis in her left eye 23 months after an uncomplicated combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation which progressed to slceral perforation with uveal prolapses. The patient underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis. Surgical specimens of the area of scleral perforation were sent for histology and microbiologic studies. Analysis of surgical specimens revealed the presence of culture-proven Nocardia asteroides as a causative agent for the patient's scleral perforation. Results of her systemic autoimmune work-up were not conclusive. Successful treatment with tectonic scleral reinforcement with donor corneal tissue and preserved pericardium, oral and topical trimethoprim-sulfamethoxazole and topical amikacin salvaged the globe and increased vision. The patient's final best-corrected visual acuity sixteen months after her last operation remains 20/70. Prompt surgical intervention with submission of appropriate specimens for pathological diagnosis and microbiology, along with consultation with rheumatologic and infectious disease specialists, are mandatory to minimize visual loss in cases of suspected infectious necrotizing scleritis.

Escleritis posterior: a propósito de un caso / Posterior scleritis: a purpose of a case

Se valora paciente femenino de 30 años de edad, quien presenta en ojo derecho dolor ocular profundo y disminución de la agudeza visual de un mes de evolución presentando pliegues retinales en 360º en área macular y edema del disco, se le realiza ecografía y se sugiere el diagnóstico de escleritis posterior; por lo que se indica prednisolona tópica al 1% e ibuprofeno vía oral, con mejoría del cuadro clínico. La escleritis posterior es una patología infrecuente, que se presenta en mujeres de edad media, con una variedad de presentación clínica que puede ser enmascarada por múltiples patologías del segmento posterior y puede estar asociada a enfermedades sistémicas, como Artritis Reumatoidea y enfermedad de Wegener, sobre todo en mayores de 60 años. La ecografía es el estudio más útil para su detección y seguimiento, y el tratamiento está basado en analgésicos no esteroideos, corticoesteroides sistémicos e inmunosupresores en casos de poca respuesta. Se ha evidenciado una recurrencia de hasta un 40%. En el caso presentado la escleritis posterior parece ser del tipo idiopática.

Esclerite posterior-relato de um caso / Posterior sclerits-a case report

Resumo: Objetivo: Relatar um caso de paiente jovem do sexo feminino com Esclerite Posterior Unilateral sem associaçäo com doenças reumáticas ou outras doenças sistêmicas. LOcal: Instituto de olhos e Laser de Belém (clínica privada). Método: apresentamos, neste trabalho, um caso da doença diagnosticada pela biomicroscopia de conjuntiva tenon e esclera, fundoscopia angio-retinografia fluoresceínica e video-angiografia com indocianina verde, sendo que os exames laboratoriais direcionados a doenças reumáticas e doenças sistêmicas poderiam estar associadas à doença ocular.Resultado: Os achados aftalmológicos de múltiplos pontos de descolamento do epitélio pgmentar e descolamento da retina sensorial na angio-retinografia fluoresceínica, hiperflurescência na regiäo da sclerite p[osterior na video-angiografia com indocianina vere e espessamento uveo-escleral na ultrassonografia säo relacionados à Esclerite Posterior. Conclusäo: A Esclerite Posterior, entre outras formas de apresentaçäo oftalmológica, pode apresentar-se com os achados oftalmológicos citados, como nos já referios na literatura internacional, porém, näo descritos ainda entre nós. Evidenciando ainda a hiperfluorescência, hámais ou menos dois discos diâmetros peri-papilares citados por lyon e jampol, devido à quebra da integridade da parede dos largos vasos coroidianos (au)