Sclera Flashcards
Causes of scleritis
Autoimmune Metabolic Infection Granulomatous Miscellaneous Surgically induced Idiopathic
Pathalogy of scleritis
Fibrinoid necrosis
Destruction of collagen
Infiltration of macrophages neutrophils and gaint cells
Classification of scleritis
Anterior
1 necrotising
2 non necrotising
Posterior scleritis
Symptoms of scleritis
Pain Photophobia Lacrimation Redness Diminution of vision
Complications of scleritis
Keratolysis
Keratitis
Complicated cataracts
Secondary glaucoma
Treatment of scleritis
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
Staphyloma
Local bulging of outer tunic(cornea/sclera)line by uveal tissue
Types of staphyloma
Anterior Intercalary Ciliary Equatorial & posterior Staphyloma
Anterior staphyloma
Ectasia of pseudo cornea with iris plastered behind it
Intercalary staphyloma
In limbal area Lined by root of iris Perforating injury,corneal ulcer, If not treated leads defective vision Rx: staphylectomy
Ciliary staphyloma
Lined by ciliary body
Perforting injury,scleritis,absolute glaucoma
Equatorial staphyloma
Lined by choroid
Scleritis,degenerative myopia
Posterior staphyloma
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)
Episcleritis
It is a benign recurrent inflammation of episclera,involving underlying tenons capsule but not overlying sclera
Seen in young patients
Causes of episcleritis
- idiopathic
- systemic disease-gout,rosacea,psoriasis,and connective tissue disease
- hypersensitive reaction-tubercular or streptococcal infection
- infections-herpes,tuberculosis,lyme disease & syphillis
Pathology of episcleritis
Infiltration of lymphocytes
Congestion and edema of tenons capsule and conjunctiva
Symptoms of episcleritis
Redness ,burning or foreign body sensation,
Rarely- mild photophobia,lacrimation,pain may be present
Signs of episcleritis
Simple episcleritis-
- sectorial inflammation of episclera
- engorged vessel runs radially beneath conjunctiva
Nodular episcleritis -
- pink or purple flat nodule2-3 mm away from limbus
- nodule is firm and tender and can be moved separately
Clinical course of episcleritis
Last for 10 days to 3 weeks and resovle spontaneously
Differential diagnosis of episcleritis
Confused with-
- conjunctivitis
- inflamed pinguecula
- swelling and congestion due to foreign body
- scleritis very rarely
Treatment of episcleritis
- topical artificial tears
- topical steroids drops
- topical nsaid
- cold compresses
- systemic nsaid’s
Scleromalacia perforans
- 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.
Scleritis
Chronic inflammation of sclera proper
Rare, but cause visual impairment & even eye loss
Seen commonly in elderly patients
