Presenting Author - Tanuj R. Sharma, Co Authors: Mayur R. Moreker, Shashank Akerker, Vinod R Goyal, Rashmikant C. Patel.

1. Tuberculous Scleritis
vs.
ANCA-Positive Scleritis
Tanuj R. Sharma
Mayur R. Moreker
Shashank Akerker
Vinod R Goyal
Rashmikant C. Patel
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences
Dr. Tanuj R. Sharma
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences , Mumbai.

2. Purpose
To describe clinical features to help distinguish
Tuberculous Sclerokeratitis from ANCA-positive Scleritis.
Methods
Retrospective Case Series
3 patients
• Two - Tuberculous Sclerokeratitis
• One ANCA-Positive Scleritis.
Dr. Tanuj R. Sharma
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences , Mumbai.

3. Methods
2 patients had a non-necrotizing anterior scleritis.
• Scleral inflammation in a nodular pattern parallel to
the limbus and separated from it by a lucid interval.
• Positive Mantoux test but no evidence of systemic
tuberculosis on physician examination and baseline
and/or advanced investigations.
Dr. Tanuj R. Sharma
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences , Mumbai.

4. Scleritis
Keratitis
Lucid Interval
Parallel to limbus
Tuberculous Sclerokeratitis

5. 18-11-2010
Tuberculous Sclerokeratitis
Started on Anti-Koch’s Treatment for “Presumed Ocular Tuberculosis”
INH + R + PZA + ETH for 2 months, followed by INH + R for 10 months
with use of only topical steroids

6. 20-04-2011
Tuberculous Sclerokeratitis
5th month of Anti-Koch’s Treatment - Resolution of Scleritis.
Topical Steroids tapered and stopped.
No recurrences after completion of Anti-Koch’s Treatment.

7. Methods
One patient
• Past history of tuberculous meningitis
• Scleral inflammation was more diffuse and had an
associated scleral thinning.
• Strongly positive p-ANCA.
•Treated with oral Methotrexate & only topical steroids
despite a past history of Tuberculous Meningitis
Dr. Tanuj R. Sharma
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences , Mumbai.

8. 27-07-2009
ANCA Positive Scleritis
•ESR - 80 mm (1 hour); MT: 2 TU, 23 X 18 mm (72 hours)
•Collagen Vascular Profile - ANA: ++, ANCA: 26.9 RU/ml (Strongly Positive)
•Thyroid Antibodies - Strongly Positive
Scleritis Scleral necrosis

9. 13-11-2010
ANCA Positive Scleritis
•On Oral Methotrexate (After 15th month of Treatment). ANCA: Negative
•1st Day Post Phacoemulsification with Foldable PCIOL
•BCVA: 6/9 with pH

10. Necrotising scleritis has been more
frequently associated with ocular complications as well
as systemic rheumatologic diseases such as Rheumatoid
Arthritis, Wegener’s Granulomatosis and Relapsing
Polychondritis.
H Keino, T Watanabe, W Taki, et al.
Clinical features and visual outcomes of Japanese patients with scleritis.
Br J Ophthalmol 2010 94: 1459-1463
Discussion
Dr. Tanuj R. Sharma
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences , Mumbai.

11. Tuberculosis might be involved in the pathogenesis of
scleritis in some patients, particularly in eyes that
present with localised elevated nodules of the sclera.
Tabbara KF. Tuberculosis.
Curr Opin Ophthalmol 2007; 18: 493-501.
Discussion
Dr. Tanuj R. Sharma
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences , Mumbai.

12. Conclusion
• Knowledge of the clinical features distinguishing
Tuberculous Sclerokeratitis from ANCA-positive Scleritis
is important.
•This allows the clinician to have more tailored
investigations.
•This further allows use of specific systemic therapy
leading to resolution of scleral inflammation and clinical
remission.
Dr. Tanuj R. Sharma
Taparia Institute of Ophthalmology
Bombay Hospital Institute of Medical Sciences , Mumbai.