Sclera

Question 1

Causes of scleritis

Answer 1

Autoimmune 
Metabolic
Infection 
Granulomatous
Miscellaneous 
Surgically induced 
Idiopathic

Question 2

Pathalogy of scleritis

Answer 2

Fibrinoid necrosis
Destruction of collagen
Infiltration of macrophages neutrophils and gaint cells

Question 3

Classification of scleritis

Answer 3

Anterior
1 necrotising
2 non necrotising

Posterior scleritis

Question 4

Symptoms of scleritis

Answer 4

Pain
Photophobia
Lacrimation
Redness
Diminution of vision

Question 5

Complications of scleritis

Answer 5

Keratolysis
Keratitis
Complicated cataracts
Secondary glaucoma

Question 6

Treatment of scleritis

Answer 6

Non necrotising scleritis-
1.topical steroids eye drops
2.indonethacin systemic
Necrotising-
1.topical steroids and heavy dose of oral steroids
2.immunosuppressive drugs in non responsive cases

Question 7

Staphyloma

Answer 7

Local bulging of outer tunic(cornea/sclera)line by uveal tissue

Question 8

Types of staphyloma

Answer 8

Anterior
Intercalary
Ciliary
Equatorial & posterior
Staphyloma

Question 9

Anterior staphyloma

Answer 9

Ectasia of pseudo cornea with iris plastered behind it

Question 10

Intercalary staphyloma

Answer 10

In limbal area
Lined by root of iris
Perforating injury,corneal ulcer,
If not treated leads defective vision
Rx: staphylectomy

Question 11

Ciliary staphyloma

Answer 11

Lined by ciliary body

Perforting injury,scleritis,absolute glaucoma

Question 12

Equatorial staphyloma

Answer 12

Lined by choroid

Scleritis,degenerative myopia

Question 13

Posterior staphyloma

Answer 13

Bulging of sclera behind equator lined by choroid
Myopia,posterior scleritis,and perforating injury

Most important-AREA IS EXCAVATED WITH RETINAL VESSELS DIPPING IN IT(like cupping of optic disk in glaucoma)

Question 14

Episcleritis

Answer 14

It is a benign recurrent inflammation of episclera,involving underlying tenons capsule but not overlying sclera

Seen in young patients

Question 15

Causes of episcleritis

Answer 15

1. idiopathic
2. systemic disease-gout,rosacea,psoriasis,and connective tissue disease
3. hypersensitive reaction-tubercular or streptococcal infection
4. infections-herpes,tuberculosis,lyme disease & syphillis

Question 16

Pathology of episcleritis

Answer 16

Infiltration of lymphocytes

Congestion and edema of tenons capsule and conjunctiva

Question 17

Symptoms of episcleritis

Answer 17

Redness ,burning or foreign body sensation,

Rarely- mild photophobia,lacrimation,pain may be present

Question 18

Signs of episcleritis

Answer 18

Simple episcleritis-

1. sectorial inflammation of episclera
2. engorged vessel runs radially beneath conjunctiva

Nodular episcleritis -

1. pink or purple flat nodule2-3 mm away from limbus
2. nodule is firm and tender and can be moved separately

Question 19

Clinical course of episcleritis

Answer 19

Last for 10 days to 3 weeks and resovle spontaneously

Question 20

Differential diagnosis of episcleritis

Answer 20

Confused with-

1. conjunctivitis
2. inflamed pinguecula
3. swelling and congestion due to foreign body
4. scleritis very rarely

Question 21

Treatment of episcleritis

Answer 21

1. topical artificial tears
2. topical steroids drops
3. topical nsaid
4. cold compresses
5. systemic nsaid’s

Question 22

Scleromalacia perforans

Answer 22

• also known as anterior necrotising scleritis without inflammation
• specifically occurs in females who are affected with rheumatoid arthritis
• characterised by yellowish patch of melting sclera which later separate affected sclera from normal sclera
• this dead sclera become very thin from which iris shines
• spontaneous perforations is extremely rare.

Question 23

Scleritis

Answer 23

Chronic inflammation of sclera proper
Rare, but cause visual impairment & even eye loss
Seen commonly in elderly patients