Q14 - Disorders Of Sclera And Episclera

Question 1

Color changes of sclera

Answer 1

Red-> conjunctival/ciliary inflammation
Blue -> thin sclera
Yellow -> jaundice
Brownish -> ochronosis

Question 2

Staphyloma

Answer 2

Localized bulging (black) of thinned and weak sclera. Uveal tissue shines through. Posterior staphyloma due to severe myopia is most common.

Question 3

Ectasia

Answer 3

Thinning and bulging of sclera without uveal involvement. Secondary to inflammation.

Question 4

Episcleritis

Answer 4

Inflammation of outermost layer of sclera (most common scleral inflammation). Sec to systemic disease or viral/bacterial.
-> hyperemia, slight tenderness, can be small mobile nodules.

Question 5

Scleritis

Answer 5

Can be diffuse/localized, and either Anterior (necrotizing/non-necrotizing) or Posterior to equator. Necrotizing forms can have inflammation or not. Usually due to autoimmune/rheumatic disease.

1) Ant. Non-necr scleritis (nodular) -> painfull, non-mobile nodules. NSAIDs treatment.
2) Ant. Non-necr scleritis (diffuse) -> painfull, more severe inflammation.
3) Ant. Necrotizing scleritis w/inflammation -> painful, sclera thinnening (blue). Treatment= systemic steroids.
4) Ant. Necrotizing scleritis w/o inflammation (Scleromalacia perforans) -> painless. Yellow scleral necrotic plaques near limbus.
5) Posterior scleritis -> Painfull. May include exophthalmos and impaired motility. Treatment = systemic steroids.