Scleritis in children: Etiology, pathogenesis, clinical features, diagnostic, and treatment algorithm

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Abstract

AIM: To analyze the etiology and pathogenesis and identify clinical and diagnostic features, development of a diagnostic algorithm, and personalized treatment of scleritis in children.

MATERIALS AND METHODS: Twelve children with mono- and bilateral scleritis with disease duration of 3–9 months were observed. Biomicroscopy, ophthalmoscopy, and ultrasonography of the eyes were performed. The examination plan included consultations with a rheumatologist, otorhinolaryngologist, and dentist and laboratory blood analysis in the enzyme immunoassay to detect the presence of IgG and IgM antibodies to herpes viruses and markers of their reactivation.

RESULTS: Chronic scleritis in 58.4% of the patients was associated with immunoinflammatory rheumatic diseases: 41.7% with juvenile idiopathic arthritis and 16.7% with psoriatic arthritis. In some cases scleritis was associated with chickenpox, surgical treatment of congenital pigmented nevus of the skin of eyelids,n on the conjunctiva and oculomotor muscles, otogenic neuritis of the facial nerve. Сlinical features of anterior deep scleritis and symptoms of bacterial scleritis are described. Personalized schemes for the diagnosis and treatment of scleritis in children have been developed. Conservative treatment included instillation of glucocorticoids and non-steroidal anti-inflammatory drugs. In addition, to anti-inflammatory therapy, antibacterial drugs are prescribed only in the presence of clinical signs of bacterial scleritis; in other cases, their use is inappropriate. The indications for antiviral therapy included laboratory confirmation of herpes infection reactivation. Personalized etiotropic therapy made it possible to achieve remission of scleritis in 9–14 days.

CONCLUSION: This study analyzed the etiopathogenesis of scleritis, described the characteristic clinical features of anterior deep scleritis in children, and developed personalized diagnostic and treatment schemes.

About the authors

Ludmila A. Kovaleva

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.
Email: ulcer.64@mail.ru
ORCID iD: 0000-0001-6239-9553
SPIN-code: 1406-5609
Scopus Author ID: 682934

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Albina A. Baisangurova

Helmholtz National Medical Research Center of Eye Diseases

Email: alia-bai-5@mail.ru
ORCID iD: 0000-0002-8014-667X
SPIN-code: 2308-0920

MD, Ophthalmologist

Russian Federation, Moscow

Tatjana V. Kuznetsova

Helmholtz National Medical Research Center of Eye Diseases

Email: tatakuzn@gmail.com
ORCID iD: 0009-0005-1333-2420
SPIN-code: 4815-6968

MD, Ophthalmologist

Russian Federation, Moscow

Alina A. Zaitseva

Helmholtz National Medical Research Center of Eye Diseases

Email: alisha_klin@mail.ru
ORCID iD: 0000-0001-8852-3305
SPIN-code: 8965-1586

MD, Ophthalmologist

Russian Federation, Moscow

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2. Fig. 1. Anterior nodular deep chronic scleritis а) local edema, infiltration of the sclera and conjunctival hyperemia; and cyanotic tint of the infiltrate, translucence of the brown plate of the sclera and choroid; b) оutcome of scleritis included thinning of the sclera in the area of the resorbed infiltrate and translucence of the brown plate of the sclera and choroid.

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3. Fig. 2. Iridocyclitis: а) in the moisture of the anterior chamber, active cells 1+, b) еndothelial fogging, multiple pulverized precipitates in the lower third of the cornea.

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4. Fig. 3. Parsplanitis: а) in the anterior parts of the vitreous body multiple inflammatory cells, b) in the anterior parts of the vitreous bodymultiple aggregates of inflammatory cells and cellular detritus in the form of “snow lumps” were formed.

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5. Fig. 4. Ultrasound biomicroscopy: а) local thickening of the sclera with a decrease in its echo density, b) local thickening of the sclera and ciliary body with a decrease in its echogenicity.

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