Sclera

Question 1

Ehler danlos
Pseudoxanthoma elasticum
Osteogen imper

Answer 1

Newborn
Keratocomus
Keratoglobus

Question 2

Uvea to ectatic sclera or cornea

Answer 2

Anterior(cornea-iris)
CB(cilliary)
Bet CB and limbus(intercalary)
Posterior(near ON head -poor vision -high myopia)
Equitorial

Question 3

Episcleritis

Answer 3

Common-local inf of vasc ct overlying sclera-young-women-unilat-recurrence-unknown causeassociated local or systemic in up to 30% as (ocular rosacea-gout-infection-atopy-collagen vasc dis)

Question 4

Symptoms of episcleritis

Answer 4

Redness-mild irritation or discomfort-episcleral injection-(nodular-sectoral-diffuse)-uncommon keratitis uveitis scleritis-
Conjunctivitis ruled out by lack of palpebral injection or discharge

Question 5

Treatment of episcleritis

Answer 5

Self limited 1-2wks-
1-Chilled artificial tears (every 4/6hrs till redness resolves)
2-in case local or systemic disorder(doxycycline$100mg *2 /24hrs)
(Antimicrobial for tb,syphillis,herpesvirus)
(Local or syst NSAIDs or cortecosteroids for collagen vasc)

Question 6

Scleritis

Answer 6

Uncommon-cellular infiltration-Destruction of collagen – vascular remodeling-
causes ; Immunological mediated-infection(less common)-Local trauma[precipitate The infection]
N. B systemic diseases in up to 2/3

Question 7

Causes of scleritis

Answer 7

1
Auto immune diseases like RA
-PAN-relapsing polychondritis-systemic lupus erythematosus-ulcerative colitis
2
Granulomatous and infectious diseases
Tuberculosis-syphilis-sarcoidosis-toxoplasmosis-Herpes simplex-herpes zoster
3
Metabolic
4
Surgical induced like in case of squint or Trabeculectomy

Question 8

Lab workshop For scleritis

Answer 8

CBC-ESR-serum rheumatoid factor-serum ANCA-PPD-chest x-ray-serum FTA-ABS, VDRL-serum uric acid -urinalysis

Question 9

Symptoms of scleritis

Answer 9

Unilateral in 2/3 and bilateral in 1/3-woman more – Fifth and sixth decades-severe pain-boringin nature-wake up at night-gender-visual equity slightly reduced-intraocular pressure mildly elevated-in 1/3 of the patients concurrent keratitis or uveitis-Key clinical signIs deep violaceous discoloration of the globe due 2 dilation of the deep vascular plexus of sclera and episclera-Avascularity areas
Result from an occlusive vasculitis [Poor diagnosis]-scleral thinning often follow bouts of Inflammation-scleral necrosis[In absence of inflammation is scleromalacia perforans, Seen almost exclusively with rheumatoid arthritis patients].

Question 10

Classification of scleritis

Answer 10

1-anterior scleritis [nodular-defuse-necrotizing(classified into with inflammation or without inflammation)
2-Posterior scleritis

Question 11

Treatment of scleritis

Answer 11

Diffuse nodular scleritis; One or more of the following drugs; oral NSAIDS, oral corticosteroids [prednisolone 1 MG/KG Single Dose in the morning for one week then tapered to 20mg/day for 2-3wks], immunosuppressive agents [cyclophosphamide/methotrexate/cyclosporine/azathioprine] These should be taken in conjunction with an internist or rheumatologist
Concurrent therapy with antacids or H2 receptor blockers is advisable

Necrotizing scleritis; systemic steroids, immunosuppressive, abundant lubricants are important in scleromalacia preforans, Scleral patch may be necessary and significant risk of perforation

Local steroids and Biopsy and sub conjunctival injection of steroids never be given