Disorders of the Episclera and Sclera

Question 1

Episclera is connected to the sclera by what?

Answer 1

Fascia bulbi (Tenon’s capsule)

Question 2

Blood is supply to the episclera through the _________ arteries.

Answer 2

anterior ciliary

Question 3

Is episcleritis malignant or benign?

Answer 3

benign

Question 4

T/F Typically, episcleritis is affecting one eye.

Answer 4

True

Question 5

Which gender and age do we see more episcleritis cases?

Answer 5

female (2:1) between 20-40 years old

Question 6

What causes episcleritis?

Answer 6

stress/hormonal changes

Question 7

The two types of episcleritis are _____ and _____.

Answer 7

simple, nodular

Question 8

T/F simple episcleritis is localized inflammation.

Answer 8

False, diffused. Nodular epicleritis is localized.

Question 9

What is the test we use to rule out conjunctivitis, scleritis, pinguecula/pterygium and phlyctenular conjunctivitis from episcleritis?

Answer 9

2.5% phenylephrine test - cause blanching

Question 10

What is the Naphcon-A medication?

Answer 10

vasoconstrictors/antihistamines

Question 11

What are the Prolensa and Llevro medications?

Answer 11

NSAIDs use as anti-inflammatory drugs

Question 12

What do you prescript to patients with moderate to severe episcleritis?

Answer 12

Topical steroids (Alrex-Loteprednol or FML-Flourometholone) and oral NSAID's
need to monitor IOP because it's given steroids

Question 13

T/F The dense nerve supply to the sclera is the short ciliary nerve.

Answer 13

False, long ciliary

Question 14

What are the symptoms with episcleritis?

Answer 14

feels hot, tenderness upon palpation, photophobia, mild tearing, acute onset (min to hrs)

Question 15

What are the symptoms with scleritis?

Answer 15

1. Severe boring pain that radiates to forehead, brow, jaw and can wake the pt up at night.
2. tearing/photophobia
3. loss of vision

Question 16

Scleritis is typically associated with ______ disease.

Answer 16

systemic

Question 17

The onset of episcleritis is ________ and scleritis is ________.

Answer 17

acute, gradual

Question 18

T/F Anterior uveitis can present in scleritis patient.

Answer 18

True

Question 19

T/F Anterior uveitis can present in episcleritis patient.

Answer 19

False

Question 20

T/F sclera becomes edmatous in scleritis patient.

Answer 20

True

Question 21

_____ scleritis is the most common scleritis.

Answer 21

Diffuse

Question 22

In Nodular scleritis, it can cause a rise in IOP if the nodule is located at the _______.

Answer 22

limbus

Question 23

T/F 2.5% phenylephrine can cause blanching in scleritis.

Answer 23

False. can cause blanching in episcleritis

Question 24

What other place you want to look at when suspect nodular scleritis in the eye?

Answer 24

look at the arms and fingers. It’s associated with rheumatoid nodules (1/3 of cases).

Question 25

Where is the most common place where nodules are growing in nodular scleritis?

Answer 25

superior region

Question 26

Which scleritis is most severe?

Answer 26

Necrotizing scleritis. This is almost always associated with systemic diseases.

Question 27

Which scleritis doesn't have symptoms?

Answer 27

scleromalacia perforans. happens in elderly female with rheumatoid arthritis or rheumatoid disease

Question 28

How is posterior scleritis diagnose?

Answer 28

use ultrasound. you will see thickening of the posterior portion due to edema

Question 29

What is the ranking of likelyhood of systemic ideology in the different kind of scleritis.

Answer 29

Necrotizing > Scleromalacia > Diffuse Anterior > Nodular Anterior > Posterior

Question 30

Rheumatoid factor (RF) lab test is to rule out ___________.

Answer 30

Rheumatoid Arthritis

Question 31

Antibody antigen (ANA) lab test is to rule out ___________.

Answer 31

Systemic Lupus Erythematosus (LUPUS)

Question 32

HLA- B27 lab test is to rule out ________ and ________.

Answer 32

Ankylosing Spondylitis, Psoriatic arthritis

Question 33

Uric acid lab test is to rule out _______.

Answer 33

Gout disease

Question 34

Erythrocyte sedimentation rate (ESR) lab test is to rule out ________.

Answer 34

any inflammation conditions in the body

Question 35

RPR/FTA-ABS lab test is to rule out _______.

Answer 35

syphilis

Question 36

What is Wegener's disease.

Answer 36

It's a inflammation of the blood vessels that affects many organs in the body

Question 37

ANCA lab test is to rule out ________.

Answer 37

Wegener's granulomatosis by presenting anti-neutrophil cytoplasmic antibodies in the blood.

Question 38

X-ray work up is to rule out _______, _______, and ______.

Answer 38

Wegener's, Ankylosing Spondylitis, Rheumatoid Arthritis.

Question 39

What are the oral NSAID's you can prescript to someone as a initial therapy to treat diffuse/nodular scleritis?

Answer 39

1. Ibuptofen (800mg po TID) 2. Indomethacin (75mg po BID) 3. Naproxen (250-500mg po TID)

Question 40

Some contraindications for oral NSAID's treatment in scleritis includes what?

Answer 40

peptic ulcer disease, recent GI bleed and renal insufficiency

Question 41

What is it if you see someone with a blue sclera?

Answer 41

you might think it's osteogensis imperfecta or other connective tissue disorders or Nevus of Ota (increased melanin)

Question 42

Axenfield's loops is associated with the _______ nerve.

Answer 42

posterior ciliary

Question 43

Should you give steroid to patient with an inflamed eye?

Answer 43

No because it will make it worst