SCLERA

Question 1

1.What are the 3 layers of sclera?

2. A 30 years old lady presented with pricking sensation , discomfort and redness in the eyes for 1 month. She’s also suffering from RA. How would you differentiate episcleritis from scleritis?

How would you treat this lady?

Answer 1

1.Episclera
Scleral stroma
Lamina fusca

2.topical phenylephrine will blanch the episcleral vessels but not the deep scleral vessels in scleritis.
Also in episcleritis lesion can move over the sclera but in scleritis it does not.
Treatment
Self limiting within 1 to 2 weeks.
Artificial tears are helpful.
Topical vasoconstrictors are useful.
NSAIDS for pain.

Question 2

Scleritis classification!

Answer 2

Anterior scleritis(98%) Inflammation of sclera anterior to equator
1.Non-necrotizing
⭐Diffuse
⭐nodular
2.Necrotizing
⭐with inflammation
⭐ without inflammation
Posterior scleritis (2%) inflammation of sclera posterior to equator.

Question 3

Differentiate bw diffuse and nodular scleritis!

Answer 3

In diffuse non necrotizing scleritis, redness involves the entire sclera and it does not cause visual loss.

In nodular type,red nodule is present which can cause visual loss.

Question 4

1.Anterior necrotizing scleritis with inflammation features!

2.Anterior necrotizing scleritis without inflammation features!

3.posterior scleritis USG findings?

Answer 4

1.associated with systemic vascular disease.
There is deep vascular congestion and avascular patch occurs.
Conjunctival necrosis may occur.
Thin sera appears bluish due to underlying uvea.

2.Aka scleromalacia perforans.
Occurs in woman with RA.
Yellow scleral patch occurs.

3.USG and CT Scan in posterior scleritis shows characteristic T sign due to posterior scleral thickening and fluid in tenon’s capsule

Question 5

What is the treatment of scleritis?

Answer 5

NSAIDS
Systemic steroids
Immunosuppressants in steroid resistant cases.
Subconjunctival steroid injection in anterior scleritis.