|A.||serum angiotensin-converting enzyme|
partial sclerectomy for histopathologic evaluation
serum anti-neutrophil cytoplasmic antibody
Answer: C) serum anti-neutrophil cytoplasmic antibody
Scleritis is the inflammation in the episcleral and scleral tissues with injection in both superficial and deep episcleral vessels. It may involve the cornea, adjacent episclera and the uvea and thus can be vision-threatening. Scleritis is often associated with an underlying systemic disease in up to 50% of patients. Anterior scleritis, the most common form, can be subdivided into diffuse, nodular, or necrotizing forms. In the diffuse form, anterior scleral edema is present along with dilation of the deep episcleral vessels. The entire anterior sclera or just a portion may be involved. In nodular disease, a distinct nodule of scleral edema is present. The nodules may be single or multiple in appearance and are often tender to palpation. Necrotizing anterior scleritis is the most severe form of scleritis. It is characterized by severe pain and extreme scleral tenderness. Severe vasculitis as well as infarction and necrosis with exposure of the choroid may result. A rare form of necrotizing anterior scleritis without pain can be called scleromalacia perforans. The sclera is notably white, avascular and thin. Both choroidal exposure and staphyloma formation may occur.
Posterior scleritis, although rare, can manifest as serous retinal detachment, choroidal folds, or both. There is often loss of vision as well as pain upon eye movement.
Treatment of scleritis with periocular corticosteroids is controversial and should not be employed in the initial treatment phase. Once a definitive diagnosis is established, infectious conditions have been excluded, no tendency toward necrotizing scleritis has been observed, and a favorable response to topical or systemic corticosteroids has been established, then subconjuctival corticosteroids may be an appropriate alternative.