Episclera and Sclera Flashcards
what is the episclera made up of?
loose, fibrous elastic tissue (collagen) that contains blood vessels that nourish sclera
how is the episclera connected to the sclera?
by fascia bulbi (tenon’s capsule)
who typically gets episcleritis and how does it present?
mainly in females (20-40 years old), unilateral, benign (stress/hormonal changes)
what are the signs of episcleritis?
cornea is typically unaffected, anterior chamber is deep and quiet, sectoral redness/inflammation and mild edema
what are the symptoms of episcleritis?
range from mild-moderate: “feels hot” or uncomfortable, some tenderness on palpation, photophobia, mild tearing, acute onset
what are the two types of episcleritis?
simple (80%) and nodular (20%)
what is simple episcleritis?
diffuse or sectoral inflammation (usually more sectoral) - without nodule
what is nodular episcleritis?
discrete elevated area of inflamed episcleral tissue (more painful, prolonged 2-3 months and moveable)
what are some differential diagnoses for episcleritis?
conjunctivitis, scleritis, pinguecula/pterygium, phlyctennular conjunctivits or direct trauma (mechanical or chemical)
what happens when you perform a 2.5% phenylephrine test?
the drop will blanch or vasoconstrict the superficial vessels - if that happens you know it is episcleritis not scleritis
what causes episcleritis?
70% is idiopathic - connective tissue/vascular disease, infectious disease (herpes simplex or zoster, syphilis, lyme), dermatologic (rosacea), or atopic disease
what is some important patient education for episcleritis?
duration of treatment - can last up to 2-3 weeks and nodular can be 2-3 months there can be a recurrence up to 3-4 years
how do you treat mild cases of episcleritis?
topical vasoconstrictors/antihistamines (2-3 weeks) = Visine, Naphcon-A (be careful for rebound hyperemia)
Topical NSAIDs
how do you treat moderate to severe cases of episcleritis?
topical steroids (q1-2 hours QID) = Alrex, FML, prednisolone acetate need to monitor IOP
what are some oral NSAIDs used for episcleritis?
ibuprofen (800mg TID), Naproxen (250mg BID), and Indomethacin (25mg TID)
what is the sclera made of?
white, opaque, dense irregular collagen fibrous tissue
what is scleritis?
chronic, painful (severe stabbing pain), and potentially blinding inflammatory disease - rare condition that is typically associated with a systemic disease
what characterizes scleritis?
edema and cellular infiltration
who does scleritis typically affect and how does it present?
females over age 40
50% bilateral with unilateral presentations becoming bilateral in 5 years
what are some signs of scleritis?
sclera will have a bluish hue, vessels become engorged and tortuous, edema, peripheral cornea can become involved and anterior uveitis can be present
what are some symptoms of scleritis?
severe boring pain that radiates to forehead, brow, jaw and can wake patient up at night, gradual onset, inflammation, tearing/photophobia, decrease in VA
what are the 3 inflammatory types of anterior scleritis?
diffuse (90%), nodular (5%) and necrotizing (5%)
what is the 1 non-inflammatory type of scleritis and what is it?
scleromalacia perforans = necrosis of sclera without inflammation or ocular pain, due to arteriolar occlusion (usually elderly females with RA)
what is diffuse anterior scleritis?
most common form - doesn’t blanch with 2.5% phenylephrine, non-granulomatous inflammatory reaction, recurrence is common and has corneal involvement
