Disorders of the sclera Flashcards
Scleritis
Scleritis is a chronic, painful, and potentially blinding inflammatory disease.
Inflammation of the sclera (white outer wall of the eye)
Commonly linked with systemic autoimmune disorders, eg RA, systemic lupus erythematosus, and polyarteritis nodosa.
More common in women.
Scleritis may be classified:
- Anterior (front) scleritis (diffuse, nodular, necrotising with inflammation, and necrotising without inflammation)
- Posterior (back) scleritis (flattening of the posterior aspect of the globe, thickening of the posterior coats of the eye and retrobulbar oedema).
Signs and symptoms:
- Eye pain or tenderness
- Redness and swelling of the sclera
- Blurred vision
- Frequent tearing
- Photophobia
On exam- Can be reduced visual acuity (eye test) and abnormal pupil reactions. Slit lit lamp.
Scleritis can lead to perforation of globe.
Treatment
URGENTLY referred. <24hrs
Initial NSAID - flurbiprofen
Most patients respond well.
Steroid tablet if immunosuppressed.
Episcleritis
Episcleritis is an inflammatory condition affecting the episcleral tissue that lies between the conjunctiva and the sclera.
Episcleritis is usually a mild, self-limiting, recurrent disease.
Causes vary but it is usually secondary to other diseases such as RA, gout or TB.
Signs and symptoms:
- acute onset of mild-to-moderate discomfort,
- Painless injection.
- Photophobia and
- Watery discharge
- Redness
EXAM: eye exam, slit lamp,
Treatment
Self-limiting
Cold compreses
Oral NSAID or artifical tears for symptoms relief
