Disorders of the Episclera and Sclera Flashcards
Episclera is connected to the sclera by what?
Fascia bulbi (Tenon’s capsule)
Blood is supply to the episclera through the _________ arteries.
anterior ciliary
Is episcleritis malignant or benign?
benign
T/F Typically, episcleritis is affecting one eye.
True
Which gender and age do we see more episcleritis cases?
female (2:1) between 20-40 years old
What causes episcleritis?
stress/hormonal changes
The two types of episcleritis are _____ and _____.
simple, nodular
T/F simple episcleritis is localized inflammation.
False, diffused. Nodular epicleritis is localized.
What is the test we use to rule out conjunctivitis, scleritis, pinguecula/pterygium and phlyctenular conjunctivitis from episcleritis?
2.5% phenylephrine test - cause blanching
What is the Naphcon-A medication?
vasoconstrictors/antihistamines
What are the Prolensa and Llevro medications?
NSAIDs use as anti-inflammatory drugs
What do you prescript to patients with moderate to severe episcleritis?
Topical steroids (Alrex-Loteprednol or FML-Flourometholone) and oral NSAID's need to monitor IOP because it's given steroids
T/F The dense nerve supply to the sclera is the short ciliary nerve.
False, long ciliary
What are the symptoms with episcleritis?
feels hot, tenderness upon palpation, photophobia, mild tearing, acute onset (min to hrs)
What are the symptoms with scleritis?
- Severe boring pain that radiates to forehead, brow, jaw and can wake the pt up at night.
- tearing/photophobia
- loss of vision
Scleritis is typically associated with ______ disease.
systemic
The onset of episcleritis is ________ and scleritis is ________.
acute, gradual
T/F Anterior uveitis can present in scleritis patient.
True
T/F Anterior uveitis can present in episcleritis patient.
False
T/F sclera becomes edmatous in scleritis patient.
True
_____ scleritis is the most common scleritis.
Diffuse
In Nodular scleritis, it can cause a rise in IOP if the nodule is located at the _______.
limbus
T/F 2.5% phenylephrine can cause blanching in scleritis.
False. can cause blanching in episcleritis
What other place you want to look at when suspect nodular scleritis in the eye?
look at the arms and fingers. It’s associated with rheumatoid nodules (1/3 of cases).
Where is the most common place where nodules are growing in nodular scleritis?
superior region
Which scleritis is most severe?
Necrotizing scleritis. This is almost always associated with systemic diseases.
Which scleritis doesn’t have symptoms?
scleromalacia perforans. happens in elderly female with rheumatoid arthritis or rheumatoid disease
How is posterior scleritis diagnose?
use ultrasound. you will see thickening of the posterior portion due to edema
What is the ranking of likelyhood of systemic ideology in the different kind of scleritis.
Necrotizing > Scleromalacia > Diffuse Anterior > Nodular Anterior > Posterior
Rheumatoid factor (RF) lab test is to rule out ___________.
Rheumatoid Arthritis
Antibody antigen (ANA) lab test is to rule out ___________.
Systemic Lupus Erythematosus (LUPUS)
HLA- B27 lab test is to rule out ________ and ________.
Ankylosing Spondylitis, Psoriatic arthritis
Uric acid lab test is to rule out _______.
Gout disease
Erythrocyte sedimentation rate (ESR) lab test is to rule out ________.
any inflammation conditions in the body
RPR/FTA-ABS lab test is to rule out _______.
syphilis
What is Wegener’s disease.
It’s a inflammation of the blood vessels that affects many organs in the body
ANCA lab test is to rule out ________.
Wegener’s granulomatosis by presenting anti-neutrophil cytoplasmic antibodies in the blood.
X-ray work up is to rule out _______, _______, and ______.
Wegener’s, Ankylosing Spondylitis, Rheumatoid Arthritis.
What are the oral NSAID’s you can prescript to someone as a initial therapy to treat diffuse/nodular scleritis?
- Ibuptofen (800mg po TID)
- Indomethacin (75mg po BID)
- Naproxen (250-500mg po TID)
Some contraindications for oral NSAID’s treatment in scleritis includes what?
peptic ulcer disease, recent GI bleed and renal insufficiency
What is it if you see someone with a blue sclera?
you might think it’s osteogensis imperfecta or other connective tissue disorders or Nevus of Ota (increased melanin)
Axenfield’s loops is associated with the _______ nerve.
posterior ciliary
Should you give steroid to patient with an inflamed eye?
No because it will make it worst
