sclera

Question 1

Episcleritis

Answer 1

inflammation of the loose connective tissue between the sclera and the conjunctiva
very common

Question 2

Episcleritis signs

Answer 2

unilateral
Cornea is typically unaffected
Anterior chamber is deep and quiet
Typically sectoral redness/inflammation
Mild edema present

Question 3

Episcleritis types

Answer 3

simple & nodular

Question 4

Nodular signs

Answer 4

More painful
More prolonged course
Moveable
last up to 2 months

Question 5

Episcleritis diffrentiation

Answer 5

2.5% phenylephrine test

Question 6

Episcleritis mild cases treatment

Answer 6

Topical vasoconstrictors/antihistamines (2-3 wk.s)
Topical NSAID’s
Typically shorter tx timeframe with
topical NSAID’s (7-10 days)

Question 7

Episcleritis severe cases treatment

Answer 7

Topical steroids – q1-2h / qid
Pred-Forte (strong steroid) ,Acetate penetrates better into AC
Alrex= mild steroid- approved for allergic conjunctivitis
FML= mild steroid for surface

Question 8

Necrotizing scleritis treatment

Answer 8

immunosuppressive drugs are started and supplemented with oral steroids

Question 9

Scleritis - Treatment

Answer 9

Oral NSAID’s (initial therapy)

oral corticosteroids *severe/necrotizing

Question 10

conditions of the Episclera and Sclera

Answer 10

Thinning / Ectasia (Anterior-Due to inflammation
Posterior-Due to high myopia)
Icteric sclera-Typically bilateral yellow
Blue sclera-normal in infants
Axenfeld’s loops
Ocular melanosis
Hyaline Plaques

Question 11

Scleritis

Answer 11

Is a chronic, painful, and potentially blinding inflammatory disease.
characterized by edema & cellular infiltration
Rare & associated with systemic autoimmune disorders.

Question 12

Scleritis - Signs

Answer 12

bluish hue ,Ulceration in peripheral cornea

Question 13

Scleritis - Types

Answer 13

Anterior Inflammatory types-Diffuse (90%),Nodular (5%)
Necrotizing (5%),Scleromalacia Perforans (non-inflammatory)
Posterior Scleritis

Question 14

Diffuse Scleritis

Answer 14

common, Is a non-granulomatous inflammatory reaction,

Involves the anterior portion of the sclera, Does not blanch with 2.5% phenyl, Corneal involvement (30%)

Question 15

Nodular Scleritis

Answer 15

Presence of single or multiple nodules
reoccur at the same site (sup.)
Nodules at the limbus can cause a rise in IOP
Associated with rheumatoid nodules in 1/3 of cases

Question 16

Necrotizing Scleritis

Answer 16

Most severe form of scleritis
Vasculitis infection.
Half pt will develop other complications
Almost always associated with systemic disease (inflammatory)
Areas of necrotic scleral tissue

Question 17

Posterior Scleritis

Answer 17

Presents with few signs unless anterior segment is involved.
Symptoms = poor or double vision, severe pain, and proptosis
DFE – may see papilledema, choroidal folds, CME, and retinal hemorrhage or detachment

Question 18

Flattening of the posterior aspect of the globe,
Thickening of the posterior coats of the eye
Retrobulbar edema.
are sign of ?

Answer 18

Posterior Scleritis

Question 19

Scleritis - Etiology

Answer 19

Autoimmune (50%):
Infectious (7%)
Miscellaneous (2%)