Diseases of the External Eye Flashcards by Earl Pineda

Q

3 Parts of Conjuctiva

A

Palpebral
Forniceal
Bulbar

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Q

Lines the anterior sclera

A

Bulbar conjunctiva

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Includes the caruncle and plica semilunaris at the medial canthus

A

Bulbar Conjunctiva

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Q

How many layers of epithelial cells are found in conjunctiva

A

2-5 layers of stratified columnar epithelial cells

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Q

What kind of epithelium lines the conjunctiva?

A

Stratified Columnar

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Q

Superficial or Basal Epithelium of Conjunctiva?

Secretes goblet cells and makes conjunctiva moist

A

Supeficial

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Q

Superficial or Basal Epithelium of Conjunctiva?

Contains Melanocytes and Lymphocytes

A

Basal

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Q

2 Parts of Conjunctival stroma

A

Superficial adenoid and deep or fibrous

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Q

when is superficial adenoid begins to form?

A

2nd to 3rd month of life

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Q

Conjunctival stroma that contains lymphoid tissue and follicle like structures

A

Superficial adenoid conjunctival stroma

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Q

Connective tissue loosely bound to tarsus

A

Deep or Fibrous Stroma conjunctival stroma

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Q

Accessory lacrimal glands found in the deep/ fibrous stroma of conjunctiva

A

Krause and Wolfring

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Q

Signs of Conjunctival Pathology

A

Vascular changes
Hyperemia
Dilated Vessels
Swelling/Edema/Chemosis
Discolorations
Discharge
Masses

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Q

Icteria affects the sclera or conjunctiva?

A

Conjunctiva

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Q

Symptoms of Conjunctival Pathology

A

Discomfort
Foreign body sensation
Itching
Burning sensation
Tearing

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Q

Categorize Conjunctival Injection:

Conjunctivitis

A

Conjunctival

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Q

Categorize Conjunctival Injection:

Corneal Ulceration

A

Mixed

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Q

Categorize Conjunctival Injection:

Rosacea

A

Pericorneal

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Q

Categorize Conjunctival Injection:

Foreign body near the limbus

A

Pericorneal

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Q

Categorize Conjunctival Injection:

Herpetic keratitis

A

Pericorneal

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Q

Categorize Conjunctival Injection:

Episcleritis

A

Ciliary

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Categorize Conjunctival Injection:

Scleritis

A

Ciliary

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Q

Categorize Conjunctival Injection:

Disciform Keratitis

A

Ciliary

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Q

Categorize Conjunctival Injection:

Iritis

A

Ciliary

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Categorize Conjunctival Injection: Cyclitis

Ciliary

Congestion at the periphery | The color is more redish

Conjunctival Congestion

Congestion is more at the perilimbar area (beside the limbus)

Ciliary Congestion

What vessels are involved in Ciliary congestion?

Anterior (Deep) Conjunctival Vessels

Congestion that is more localized

Pericorneal Congestion

How to differentiate Conjunctival from Ciliary Congestion using ocular decongestant?

Ocular decongestant is only efficient in conjunctival congestion

2 major reactions that occur in conjunctiva

Follicular and Papillary Reaction | But mixed type can occur

What vessels are involved in Conjunctival congestion?

Posterior (Superficial) Conjunctival Vessels

What conjunctival reaction will have lymphoid germinal centers?

Follicular Reaction

What conjunctival reaction will have smooth nodules?

Follicular reaction

What conjunctival reaction will have avascular apices surrounded by fine vessels at the base?

Follicular reaction

Pathogens involved in Follicular reaction

``` Adenovirus Enterovirus Molluscum contagiosum HSV Chlamydia Drug toxicity ```

What conjunctival reaction will have non specific response?

Papillary reaction

Papillary reaction is seen on?

Upper Tarsal Conjunctiva

What pattern is seen in Papillary reaction?

Fine mosaic pattern of dilated telangiectatic vessels

In papillary reaction, each papilla has a central fibrovascular core that gives rise to a vessel branching out in a _____ pattern

Spoke-like

3 Major types of conjunctivitis

Bacterial Viral Allergic

Mainstay of treatment in Viral Conjunctivitis

Supportive Treatment Steroids Frequent handwashing

Pathogen involved in Epidemic Keratoconjunctivitis

Adenovirus 8, 11, 19 | Clue: 8+ 11 is 19

Pathogen involved in Pharyngoconjunctival fever

Adenovirus 3, 4, 7

Onset of Viral Conjunctivitis

Acute

Onset of Bacterial Conjunctivitis

Acute

Onset of Gonococcal / Newborn Conjunctivitis

Hyperacute

Manifestation of Viral Conjunctivitis

Watery Discharge Pre-auricular lymphadenopathy Mixed papillary- follicular ``` Others: Photophobia Foreign body sensation Chemosis Subconjunctival hemorrhage Pseudo membrane or true membrane ```

Usual complaint in Bacterial conjunctivitis

Cant open eyes because of matting

Manifestation of Bacterial conjunctivitis

Purulent or mucopurulent discharge Photophobia Foreign body sensation Matting of eyelashes

Most common etiology of Bacterial conjunctivitis

``` Staphylococcus Streptococcus Chlamydia Haemophilus Neisseria gonorrhoeae ```

Mainstay of treatment in Bacteria Conjunctivitis

Antibiotics

Description of discharge in gonococcal conjunctivitis

Cheesy

Mode of transmission of gonococcal conjunctivitis

Genital-Hand-Ocular transmission example: Myth of treating eyes with urine

Involvement of cornea in Gonococcal conjunctivitis can progress to?

Melting and perforation of intact epithelium

Classic cause of neonatal conjunctivitis

Perinatal transmission

Gram stain result of Gonococcal conjunctivitis

Presence of Gram negative intracellular diplococci Coffee/ kidney shaped diplococci

Antibiotic used in Gonococcal conjunctivitis

Ceftriaxone Adults: 500- 1000 mg Children: 250 mg

Concurrent infection with gonococcal conjunctivitis

Chlamydia

Antibiotic used in gonococcal conjunctivitis plus chlamydia

Azithromycin

Other name for Chlamydial conjunctivitis

Inclusion Conjunctivitis

Etiology of Chlamydial Conjunctivitis

Chlamydia trachomatis D to K

Conjunctival response in Chlamydial Conjunctivitis

Follicular response with non tender lymphadenopathy

Gram stain result of Chlamydial conjunctivitis

Presence of inclusion bodies

Sequelae of Chlamydial conjunctivitis

Trachoma

Other diseases in concurrent with Chlamydial conjunctivitis

Urethritis | Cervicitis

Result of neovascularization in trachoma

Pannus

Evidence of scarring on the conjunctiva in Trachoma

Arlt's line

Basedown configuation of keratic precipitates on the corneal epithelium

Arlt's triangle

Duration of Viral conjunctivitis

3 days to 1 week

Arlt's Trangle is seen in?

Uveitis

Elevated lesion found under the lids causing constant pressure with the cornea and limbus can cause?

Herbert's pit

In acute setting, follicular conjunctivitis and epithelial keratitis can be seen in?

Trachoma

Depression or atrophic follicles at the corneal limbus representing areas that are slightly thinned out

Herbert's pit

True of False | Herbert's pit can lead to secondary bacterial infection

True

What type of hypersensitivity is Allergic Conjunctivitis?

Type 1

Hallmark of Allergic Conjunctivitis

Itching

What type of immunoglobulin is present in allergic Conjunctivitis?

IgE

What type of allergen causes allergic Conjunctivitis?

Airborne allergens

Temporal profile of allergic Conjunctivitis

Episodic and Short lived

Presence of diffuse papillary hypertrophy with giant cobblestone papillae

Vernal keratoconjunctivitis

treatment of vernal keratoconjunctivitis

Topical antihistamines Mast cell stabilizers Steroids

Signs and symptoms of vernal keratoconjunctivitis

``` Intense itching Blepharospasms Photophobia Blurred vision Copius mucoid discharge ```

Epidemiology of Vernal Keratoconjunctivitis

Young males 4-16 yo History of Atopy

Type of Seasonal, Reccuring, Bilateral Allergic Conjunctivitis

Vernal Keratoconjunctivitis

Pathognomonic to Limbal Vernal Keratoconjunctivitis

Horner Trantas Dots

Limbus is thickened and gelatinous with scattered opalescent mounds and vascular injection

Limbal Vernal Keratoconjunctivitis

Oval or shield-shaped sterile epithelial ulcers with underlying stromal opacification

Shield ulcer

Chronic Inflammation of the conjunctiva with prominent papillary hypertrophy

Giant Papillary Conjunctivitis

Commonly associated with contact lens use (protein debris and chemical cleansers)

Giant Papillary Conjunctivitis

Seen in Ocular prosthesis, Loose Nylon Suture sand Filtering blebs

Giant Papillary Conjunctivitis

Rupture of conjunctival blood vessel due to trauma, valsalva, blood dyscrasia or infection Or pooling of blood in the subconjunctival space

Subconjunctival Hemorrhage

True or False | Subconjunctival hemorrhage will cause blurring of vision

False

Treatment of Subconjunctival Hemorrhage

``` Observe (7-14 days) Vitamin C Ocular Lubricants Cold compress (1st 12 to 24 hrs) Warm compress succeeding hours ```

Congenital hamartomas that consists of nests of modified melanocytes

Conjunctival Nevus

Modified melanocytes also know as?

Nevus cells

Types of Conjunctival Nevus

Junctional Compound Subepithelial

True or False | Conjunctival Nevus are usually malignant

False

Represent trapped foreign body such as dust in the conjunctival epithelium

Conjunctival Concretions

Symptom of Conjunctival Concretions

Foreign body sensation

Elevated, fleshy conjunctival masses located in the inter-palpebral region, most commonly on the nasal side

Pinguecula

Worsened Pinguecula can lead to?

Pterygium

Usual color of Pinguecula

Yellow or light brown

Associated conditions with Pinguecula

Chronic Actinic exposure Repeated Trauma Dry windy condition

Triangular wing-shaped fleshy fibrovascular tissue encroaching upon the cornea occurring at the nasal side but can also occur in both nasal and temporal

Pterygium (Pugita)

Pterygium that meets at the center is called

Kissing Pterygium

Aka Surfer's Disease

Pterygium

Risk Factors for Pterygium

``` UV light Wind & dust Farmers Fishermen People exposed to sunlight ```

Indications for surgery in Pterygium

Reduced vision due to invasion of visual axis Irregular astigmatism Significant ocular irritation

True or False | Pyrogenic represents granulomatous inflammation

False

Reactive proliferation of vascular endothelial cells and granulation tissue

Pyrogenic Granuloma

Raised, fleshy, red, pedunculated lesion from skin or conjunctiva

Pyrogenic Granuloma

Occurs after inflammatory conditions such as chalazia or chemical burns, or after conjunctival surgery

Pyrogenic Granuloma

If you suture from a cataract extraction or pterygium excision, you can also get this type of granuloma due to the retained sutures

Suture Granuloma

Clinically appears similar to a pyogenic granuloma

Suture Granuloma

Management for Suture Ganuloma

Remove suture | Steroids

Focal, translucent lymphocytic nodules located at the limbus

Conjunctival/ Corneal Phlyctenules

What type of hypersensitivity is Conjunctival/ Corneal Phlyctenules?

Type 3 or Cell Mediated

Pathogens involved in Conjunctival/ Corneal Phlyctenules

Staphylococcus | TB bacilli

Management for Conjunctival/ Corneal Phlyctenules

Steroids | Treat underlying cause

Commonly seen in Children with Tuberculosis

Conjunctival/ Corneal Phlyctenules

If Conjunctival/ Corneal Phlyctenules wander across the cornea, what will happen?

Vascularization and Scarring

True or False | Conjunctival Viral Papilloma is malignant

False (but can be premalignant in older adults)

Agent of Conjunctival Viral Papilloma

Papilloma Virus

Treatment of Conjunctival Viral Papilloma

Excision and Cryotherapy

Localized to the epithelium, does not invade the epithelial basement membrane

Conjunctival Intraepithelial Neoplasia (CIN)

Treatment of Conjunctival Intraepithelial Neoplasia (CIN)

Excision and Cryotherapy

Pathognomonic sign of Conjunctival Intraepithelial Neoplasia (CIN)

Gelatinous, sessile appearance with corkscrew like vessels at the limbus

Intraepithelial melanocytes proliferation → multiple flat, brown patches of unilateral pigmentation within superficial conjunctiva

Conjunctival Primary Acquired Melanosis (PAM)

Nodules develop in previously flat lesion

Conjunctival Primary Acquired Melanosis (PAM)

Malignant potential of Conjunctival Primary Acquired Melanosis (PAM)

Melanoma (20-30%)

What type of hypersensitivity is Atopic KC?

Type 1 IgE Mediated Immediate Anaphylactic Hypersensitivity

What type of hypersensitivity is Hay Fever Conjunctivitis

Type 1 IgE Mediated Immediate Anaphylactic Hypersensitivity

What type of hypersensitivity is Chronic Cicatricial Conjunctivitis?

Type 2 | Cytotoxic

What type of hypersensitivity is Ocular Cicatricial Pehphigoid?

Type 2 | Cytotoxic

What type of hypersensitivity is is Keratoconjunctivitis Sicca? (Sjogren Syndrome)

Type 3 | Immune/ Ag-Ab Complex mediated

What type of hypersensitivity is Plytenulosis?

Type 4 | Delayed hypersensitivity

What type of hypersensitivity is corneal transplant rejection?

Type 4 | Delayed hypersensitivity

What type of hypersensitivity is reaction to chemical exposure?

Type 4 | Delayed hypersensitivity

What type of collagen is present in Decrement's Membrane of cornea?

Type 3 (and type 4)

What type of collagen is present in Epithelial basement membrane and Decrement's Membrane of cornea?

Type 4

Major collagen type present in cornea

Type 1- 90% | Type 2- 10%

Thickness of cornea

0. 5- 0.6 mm at center | 0. 6- 0.8 mm at lumbus

Diameter of cornea

11.5- 11.7 mm

True or False | Cornea has myelinated nerve endings

False (Unmyelinated)

True or False | Cornea is avascular

True

How cornea receive its nutrients?

Diffusion | From Neurotrophins

True or False | Cornea is the anterior 10% of the eye

True

What is the main function of Cornea?

Optical function/ Transmission of light/ Light Refraction Structural integrity Protects ocular content

What are the 2 parts of the eye with refractive power?

Cornea (major/ 2/3) | Lens (minor/ 1/3)

Total refractive power of the eye

60D

Refractive power of cornea

42- 43 D

Refractive power of lens

19- 35 D

Corneal inflammation aka?

Keratitis

Keratits associated with tissue necrosis, may involve all corneal layers, and usually form a microbial cause

Ulcerative Keratitis

Keratitis not associated with tissue loss/ necrosis

Non-ulcerative Keratitis

Bacterial cause of Keratitis

``` Staphylococcus Streptococcus Pseudomonas Moraxella Haemophilus Neisseria Enterobacteria Nocardia Mycobacterium ```

Fungal cause of Keratitis

Aspergillus Fusarium Mycelia Candida

Parasitic cause of Keratitis

Acanthamoeba Microsporida Toxocara

Viral cause of Keratitis

``` HSV VZV Adenovirus EBV Poxvirus ```

Medical term for pus in the eye, characteristic of Bacterial Keratitis

Hypopyon

Brush like border of bacterial keratitis

Pseudomonas

Distinct border of bacterial keratitis

Streptococcus Staphylococcus Moraxella

Advancing border of bacterial keratitis

Streptococcus

Aka Dry eye disease

Non-ulcerative Keratitis

Bacterial/ Fungal/ Parasitic or Viral Keratitis? ``` Acute Painful Red eye Decreased vision Rapid evolution Persistent mucopurulent discharge Trauma or Contact Lens use Associated eye disease ```

Bacterial

Bacterial/ Fungal/ Parasitic or Viral Keratitis? ``` Slow Red Painful eye Decreased vision Trauma with organic/ vegetable matter (leaves or twigs) Topical steroid use ```

Fungal

Atypical border of bacterial keratitis

Mycobacterium

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Sticky Hypopyon

Fungal

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Satellite Lesion and Feathery Borders

Fungal

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Presence of epithelial plaque

Fungal

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Presence of Immune ring

Fungal

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Presence of Scleritis

Fungal and Parasitic

Gram stain and Giemsa stain result of Fungal Keratitis

Presence of Hyphal element

Bacterial/ Fungal/ Parasitic or Viral Keratitis? ``` Slow Protracted progressive course Red eye Severe pain out of proportion with clinical findings (patient seems to be acting only) Decreased vision +/- CTL use Commonly mis-dx as HSV ```

Parasitic (Acanthamoeba) Keratitis

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Severe Pain out of Proportion

Parasitic (Acanthamoeba) Keratitis

Parasitic (Acanthamoeba) Keratitis is commonly misdiagnosed as?

HSV infeciton

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Punctate epithelial keratitis

Parasitic (Acanthamoeba) Keratitis and Viral Keratitis

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Radial perineuritis

Parasitic (Acanthamoeba) Keratitis

Seen in late phase of Parasitic Keratitis

Ring infiltratrates

Culture result in parasitic keratitis

E. coli overlay

Calcofluor white stain result of parasitic keratitis

Double walled cyst

Calcofluor white stain result of parasitic keratitis

Double walled cyst

Bacterial/ Fungal/ Parasitic or Viral Keratitis? ``` Subacute Red eye Decreased vision Photophobia Less painful Mild foreign body sensation +/- trauma, Associated illness or stress Majority of patients have a recurrent ocular disease ```

Viral

Bacterial/ Fungal/ Parasitic or Viral Keratitis? ``` Subacute Red eye Decreased vision Photophobia Less painful Mild foreign body sensation +/- trauma, Associated illness or stress Majority of patients have a recurrent ocular disease ```

Viral

Temporal profile of Keratitis Bacterial? Viral? Fungal? Parasitic?

Bacterial- Acute Viral- Subacute Fungal and Parasitic- Slow

Treatment of choice in Viral Keratitis

Topical or Oral Acyclovir

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Epithelial, Stromal, Endothelial, Keratouveitis

Viral Keratitis

Bacterial/ Fungal/ Parasitic or Viral Keratitis? Coalesce, become dendritic, geographic (if with history of topical steroid use)

Viral Keratitis

What viral cause of Keratitis? Dendrites, terminal bulbs, dichotomous branching

HSV

What viral cause of Keratitis? Pseudodendrites, no terminal bulbs, heaped up epithelium, irregular branching

VSV

A multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability, with potential damage to the ocular surface

Dry eye disease

Dry eye disease is accompanied by (Increase or Decrease?) osmolarity of tear film & inflammation of the ocular surface

Increase

Most frequently diagnosed disorder in Opthalmology

Dry Eye Disease

Frequent cause of Dry Eye Disease

Ocular Irritation

Severe forms of dry eye disease ranked equivalent to _____ in quality of life utility assessments

Unstable angina

2 Types of Dry Eye Disease

Aqueous Deficient and Evaporative

2 Types of Aqueous Deficient Dry Eye disease

Sjogren Syndrome Dry Eye and Non-Sjogren Syndrome Dry Eye

Sjogren Syndrome Dry Eye or Non-Sjogren Syndrome Dry Eye? Lacrimal Deficiency Lacrimal Obstruction Reflex Block Systemic Drug

Non-Sjogren Syndrome Dry Eye

2 Types of Evaporative Dry Eye Disease

Intrinsic and Extrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Meibomian Oil Deficiency

Intrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Lid Aperture Disorder

Intrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Low blink rate

Intrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Accutane effect

Intrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Vitamin A Deficiency

Extrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Topical Drug preservative

Extrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Contact lens

Extrinsic Evaporative

Intrinsic or Extrinsic Evaporative Dry Eye? Ocular surface disease

Extrinsic Evaporative

Normal Blink rate

15 times per minute

Test for dry eye

1. TBUT (Tear Break-up Time) 2. Corneal and Conjunctival Staining 3. Schirmer's Test 4. Tear Meniscus Height

Test for dry eye that use fluorescein dye and observed through slit lamp

TBUT (Tear Break-up Time)

TBUT (Tear Break-up Time) interpretation >10 seconds

Normal

TBUT (Tear Break-up Time) interpretation 5-10 seconds

Marginal

TBUT (Tear Break-up Time) interpretation <5 seconds

Low

Test for dry eye that shows devitalized tissue in the surface of the eye

Corneal and Conjunctival Staining

Corneal and Conjunctival Staining Interpretation Presence of stain

(+) Dry eye disease

Test for dry eye that puts filter paper with graduation in the eyes then measure the wet part in mm.

Schirmer's Test

How many seconds will the patient close his/her eyes in Schirmer's Test?

5 seconds

Schirmer I or II? Without Anesthesia

Schirmer I

Schirmer I or II? Tests reflex secretion and function of the main lacrimal gland

Schirmer I

Schirmer I or II? With Anesthesia

Schirmer II

Schirmer I or II? Tests baseline secretion; function of the accessory lacrimal gland

Schirmer II

Schirmer II interpretation Aqueous deficient

<5 mm

Schirmer I interpretation Aqueous deficient

<10 mm

Normal Tear Meniscus Height

0.2- 0.4 mm

Aqueous deficient Tear Meniscus Height

<0.2 mm

Size of congenital small corneas (Microcornea)

<10 mm

Megalocornea is usually seen in?

Congenital glaucoma

“Fog or mist” corneal opacity hard to see Seen using a slit lamp exam

Macula Remember: Slit Lamp- Macula Penlight- Nebula Sunlight- Leukoma

“Stain or spot” corneal opacity Seen using a penlight

Nebula Remember: Slit Lamp- Macula Penlight- Nebula Sunlight- Leukoma

Very prominent corneal opacity Easily seen by direct sunlight

Leukoma Remember: Slit Lamp- Macula Penlight- Nebula Sunlight- Leukoma

Abnormal protrusion of the uveal tissue through a weak point in the eyeball

Staphyloma

Thinning of corneal stroma

Kerectasia/ Keratectasia

Cholesterol deposition around the limbus

Arcus senilis

Seen in juvenile arthritis | Deposition of Calcium in the bowman's membrane

Calcific band keratopathy

Sclera begins at the ____ and terminates as the ______

Limbus, Optic nerve canal

Dense, opaque, elastic connective tissue structure composed of bundles of collagen of varying diameters

Sclera

Comprised ~90% or 5/6 of the outer coat of the eye

Sclera

True or False | Sclera is thicker in males than females

True

Sclera is thickest near the _____

Optic Nerve (1 mm)

Sclera is thinnest at the ______

Insertion of extra ocular muscles (0.3 mm)

At the limbus, the thickest of sclera is ____ mm

0.83 mm

4 layers of sclera

Episclera Stroma Lamina Fusca Endothelium

Fibroelastic structure between the superficial scleral stroma and Tenon’s capsule

Episclera

2 Layers of Episclera

Outer parietal and deeper viscera

Associated with episcleritis

Autoimmune | Atopy and Rosacea

Treatment for Episcleritis

Self Limiting | Phenylephrine

Inflammation of the episclera

Episcleritis

True or False | Simple Episcleritis can also span the entire episclera

True

How can you differentiate Simple Episcleritis from conjunctivitis?

Simple episcleritis is more localized Vessels of episcleritis in slit lamp is fixed Does not blanch with decongestants *Conjunctivitis- diffused, movable vessels, blanching

Focal, well- defined area of intense redness and episcleral edema

Nodular Episcleritis

True or False | Episcleritis is usually painful

False

Inflammation of the Sclera | Tender globe with violaceous Sclera

Scleritis

Scleritis is more common in men or women?

Women

Common age of onset of scleritis

40- 60 yrs old

Reaction of scleritis with Phenylephrine

Does not blanch

True or False | Recurrence of scleritis is common

True (usually in both eyes)

Temporal profile of scleritis

Gradual

True or False | Scleritis is usually painful

True | SEVERE BORING PEIRCING PAIN WORSE AT NIGHT

Types of Scleritis

``` Diffuse anterior scleritis Nodular anterior scleritis Necrotizing Scleritis Scleromalacia Perforans Posterior Scleritis ```

Injection of episcleral and deep scleral vessels

Diffuse Anterior Scleritis

True or False | Scleral thinning is not present in Diffuse Anterior Scleritis

True

Identify type of Scleritis | (+) Bluish Translucent area with recurrent inflammation

Diffuse Anterior Scleritis

Identify type of Scleritis | (+) Vascular Congestion

Diffuse Anterior Scleritis

Scleral inflammation surrounds whitish, avascular, necrotic scleral tissue

Necrotizing Scleritis

True or False | Scleral thinning is not present in Necrotizing Scleritis

False

Identify type of Scleritis | (+) Bluish area to the sclera

Necrotizing Scleritis

Scleritis without inflammation

Scleromalacia Perforans

Identify type of Scleritis | Typical redness, pain, edema not apparent

Scleromalacia Perforans

Identify type of Scleritis | Occurs in long-standing RA

Scleromalacia Perforans

True or False | Scleral thinning is not present in Scleromalacia Perforans

False

Identify type of Scleritis | Blue-gray to dark patch of sclera

Scleromalacia Perforans

Identify type of Scleritis | (+) Hypotony

Scleromalacia Perforans

True or False | Spontaneous perforation is rare in Scleromalacia Perforans

True

Inflammation of sclera posterior to Ora Serrata

Posterior Scleritis

True or False | Scleral thinning is not present in Posterior Scleritis

True | (+) Scleral Thickening on B scan, CT scan or MRI

Identify type of Scleritis | Choroidal folds, choroidal detachment, RD, macular edema, myositis, orbital inflammation, papilledema

Posterior Scleritis

Identify type of Scleritis | Pain, tenderness, proptosis, vision loss, restricted motility

Posterior Scleritis

Identify type of Scleritis Presence of T sign on B scan signifying edema on subtendon space

Posterior Scleritis