Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ocular Disease Test 2 > Sclera and Episclera > Flashcards

Sclera and Episclera Flashcards

1
Q

Describe the anatomy to the episcelra

A

The very outer layer of the sclera
Dense, vascular CT.
Provides nutrition to sclera
Mscular fusion (syonival membrane) IE connected to Tenon’s capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the vasculature of the episclera

A

Superficial episcleral plexus and deep episcleral plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is episcleritis?

A

Benign, transient, sudden onset inflammation of episclera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What layers of episclera are involved?

A

Conjunctival vessels, deep and superficial scleral plexus (Tenon’s vessels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are symptoms of episcleritis?

A

Acute onset of redness
Mild pain but generally NOT painful
Can be recurrent
No discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are signs of episcleritis?

A

Sectorial (less commonly diffuse) redness of one or both eyes
Mild tenderness over area of episcleral injection
Nodule that is somewhat mobile
Anterior uveitis/corneal involvement is rare
VA normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What sort of history should you check for in episcleritis?

A

30% associated systemic disease, CT disease, atopy, rosacea, gout, herpes, syphillis, rheumatoid arthritis
Tend to be women more than men
History of rash, arthritis, venereal disease, recent viral ilness or medical problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some lab tests to do to check for Episcleritis?

A

ANA, rhemuatoid factor, ESR, serum uric acid level, RPR, FTA-ABS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What’s the Dx for Scleritis?

A

A deep pain that’s severe and radiates to ipsilateral face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What’s the Dx for Iritis?

A

Cells and flare in the anterior chamber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What’s the Dx for Conjunctivitis?

A

Discharge and inferior tarsal conjunctival follicles/papillae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe some noninfectious etiologies of episcleritis

A 
Idiopathic
CT disease (RA, polyarteritis nodosa, systemic lupus erthematosus, Wegener granulomatosis)
Gout (Increased serum uric acid)
Inflammatory bowel disease
Rosacea/Atopy
Thyroid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe some infectious etiologies of episceleritis

A 
Herpes zoster ivrus
Herpes simplex virus
Lyme disease
Suphilis (FTA-ABS +)
Hepatitis B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe some of the work up for episcleritis

A

External evaluation - Look for a bluish hue of scleritis
SLE (Lupus) - Conj/sclera, cornea, AC, check IOP. Anesthetisze and move conj to determine depth of injection)
Lab tests if history suggests it (ANA - antinuclear antibody, Rheumatoid factor, ESR (Erythrocyte sedimentation rate), Serum uric acid level, FTA-ABS (Syphilis))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What effect does 2.5% phenylephrine have on episcleritis?

A

Blanches the episcleral vessels (makes them clear/white) after 15 minutes and clears up some redness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name the classifications of episcleritis

A

Simple - Sectorial/Diffuse

Nodular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Of the classifications, which is the most common kind of episcleritis?

A

Simple (78-83%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe Simple Episcleritis

A

Generalized, moderate episcleral swelling and injection

See greyish infiltrates and will resolve in first 3 weeks half the time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe Nodular episcleritis

A

See a nodule of localized edema within area of injection (Red bump in the red patch)
Single or multiple nodules
MOVABLE nodule over deep episcleral plexus
Takes longer to resolve than simple episcleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you treat episcleritis?

A

SELF LIMITING, No treatment required. Treatment is for patient peace of mind
Mild - Chilled artificial tears, decongestants and cold compresses topically
Moderate - Mild topical steroid (Loteprednol or flurometholone) with tapering
Oral NSAID/ASA ok too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe how a follow up for episcleritis would go

A

If on steroids, check weekly and do IOP

If on artificial tears/vasoconstrictors, check in 2-3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe Chronic/Stubborn Episcleritis

A

Rare, nodule formation,scleral thinning possible (not necrosis), trasparency and ‘bluish’ color

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you treat chronic episcleritis?

A

NSAIDs, oral steroids (better option)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Can a chronic episcleritis become scleritis?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe the anatomy of the sclera

A

Collage and elastic bundles, a firm and flexible protective layer.
Rich nerve sypply via long ciliary nerves
AVASCULAR
Low metabolism supplied by choroid and episclera
Fully hydrated
Continuous with corneal stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Highlighting anatomy - What supplies the metabolic needs of sclera?

A

Choroid and episclera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Is the sclera vascular?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the sclera continuous with?

A

Corneal stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is scleritis?

A

Uncommon CHRONIC granulomatous inflammatory disease of sclera, both anterior or posterior.
Inflammation affects deep episcleral plexus, (choroidal vasculature) gives it a dark red with blue tint
Can blind patients and half tend to be associated with underlying disease, CT disease or trauma/infection

30
Q

Describe anterior scleritis

A

Non-nectorizing (85%). VA ok unless uveitis occurs. Patient presents with redness of eye and SEVERE eye pain

31
Q

Describe posterior scleritis

A

Scleritis without pain or redness. Can have EOM restriction, proptosis and permenant decreased VA.
May see an amelanotic choroidal mass (no color)
Usually unrelated to systemic disease

32
Q

What age and population tend to be most affected by scleritis?

A

40-60 years and females>males 8 to 5

33
Q

What kind of complications can arise from scleritis affecting the choroidal vasculature?

A

Intraocular complications - uveitis, retinitis/retinal detachment, glaucoma, CAT, cornea (peripheral keratitis, limbal guttering)

34
Q

Describe some symptoms for scleritis

A

SEVERE OCULAR PAIN (Deep boring radiating pain that can wake from sleep, goes from temple, brow, jaw or sinus)
Gradual onset red eye with decreasing VA
Recurrent episodes
Scleromalacia perforans (holes in sclera) but may have minimal symptoms

35
Q

Describe some signs of scleritis

A

Inflammed sclera, episcleral or conjunctival vessels
Injection of vessels, giving sclera/conj a red look
Sclera has bluish hue (Best seen in natural light) - Sclera may be thing or edematous
Photophobia or tearing of sclera

36
Q

What is the Dx for episcleritis

A

Sclera not involved, blood vessels blanch with topical phenylephrine
More acute onset than scleritis
Patient will be younger generally speaking
Mild to no symptoms

37
Q

What are some systemic causes for scleritis?

A 
50% of cases associated with systemic diseases:
Collagen diseases
Metabolic diseases
Granulomatous disease
Infectious diseases
Ocular diseases
38
Q

What are and describe the two kinds of anterior scleritis

A

Diffuse - Widespread inflammation of anterior sclera that is most common kind and most benign (no progression)
Nodular - 1+ erythematous (red patch) with immovable, tender inflamed nodules on anterior sclera. 20% become necrotizing and takes up to 8 weeks to clear

39
Q

How do you treat diffuse/nodular anterior scleritis?

A

Oral NSAIDs
Oral prednisone with slow tapering
Immunosuppressive therapy –> systemic steroids used with NSAIDs

40
Q

When selecting oral NSAIDs to treat anterior scleritis, how would you know the treatment was not working?

A

Prescribing three different NSAIDs and all must fail before calling treatment failed

41
Q

Describe anterior necrotizing scleritis

A

Most severe form of scleritis and has vision threatening complications (permanent)
Severe pain, damage to sclera is significant and becomes transparent
See a necrotic/avascular patch and can have conjunctival perforation

42
Q

What class of systemic conditions can cause anterior necrotizing scleritis with inflammation? (Give example)

A

Systemic collagen vascular disorders like Rheumatoid arthritis

43
Q

Describe the ophthalmic emergency that can occur with scleritis

A

Anterior necrotizing scleritis with inflammation
Sclera thins and is blue
Gradual extreme painful red eye
Can have associated corneal inflammation

44
Q

What is corneal inflammation caused by scleritis called?

A

Sclerokeratitis

45
Q

What are some secondary complications with anterior necrotizing scleritis with inflammation?

A 
Sclerosing keratitis
Cataract
Hyphema
Retina involvement (Staphyloma, ectasia)
Secondary glaucoma
46
Q

What is Ectasia?

A

Bulging of sclera without a uveal lining

47
Q

What is Staphyloma?

A

Localized thinning of sclera with bulging of uvea into thinned/stretched area of sclera
Are named on location
Scleritis, myopia, RD, or CT disease can be involved
Check with a BIO exam and A/B scan

48
Q

What is another name for scleromalacia perforans?

A

Anterior necrotizing scleritis WITHOUT inflammation

49
Q

Describe scleromalacia perforans

A

Frequently in patients with long standing RA –> Formation of a rheumatoid nodule in sclera
NO PAIN
Visible avascular patch
Thinning scleral tissue that necrotizes
Steady progression
Perforation rate is high unless the IOP is high

50
Q

How do you treat necrotizing scleritis?

A

Oral Prednisone
Immunosuppressive agents (cyclophosphamide, methotrexate, azathiprine, cyclosporin)
Abundant lubrication for scleromalacia perforans
Severe cases require scleral patch graft surgery to repair damaged corneal tissue

51
Q

What is the Dx for posterior scleritis?

A

Retrobulbar optic neuritis
Retinal detachment
Tumor
Orbital disease

52
Q

What are some signs of posterior scleritis?

A 
Optic disc swelling
Macular edema
Retinal hemorrhage
Retinal detachment
Vitritis
Choroidal folds/detachment
Intraretinal white deposits
53
Q

How do you treat a posterior scleritis?

A 
Controversial, not a lot of consensus
ASA
NSAIDs
Steroids
Immunosuppressive treatment
54
Q

In general, what is the treatment mentality when treating scleritis: Infectious etiologies

A

Use of topical/systemic antibodies

55
Q

In general, what is the treatment mentality when treating scleritis: Foreign body

A

Remove it

56
Q

In general, what is the treatment mentality when treating scleritis: What else to consider?

A

Glasses/eye shielding at all times if there is significant thinning/risk of perforation
Topical steroids are NOT effective

57
Q

What is contraindicated in treated scleritis?

A

Subconjunctival steroids, especially in necrotizing scleritis –> increased scleral thinning/perforation

58
Q

Describe the work up for scleritis

A

History - previous episodes? Systemic diseases?
Examine sclera in all directions via gross inspection in natural/adequate room light
Slit lamp exam with red-free filter to check if there are avascular zones
DFE to rule out posterior involvement
COMPLETE physical exam (CBC, ESR, uric acid, syphilis, rheumatoid factor, ANA, FBS (fasting blood sugar), PPD, radiograph of sacroiliac joints)

59
Q

How would you differentiate episcleritis and scleritis?

A 
Conjunctival manipulation (vessels move with episcleritis)
OTC decongestants (should clear up with episcleritis)
10% phenylephrine (blanching vessels with episcleritis not deep scleral vessels)
60
Q

What are the congenital anomalies?

A 
Pigment cuffs
Osteogenesis Imperfecta
Melanosis Oculi
Nevus of Ota
Tumors of the sclera
Senile hyaline plaque
61
Q

What’s a pigment cuff?

A

Common anatomical varient
Involves short anterior ciliary nerves
Bluish cuff

62
Q

Describe “Blue Sclera”

A

Tissue coloration due to scleral thinning, exposing uvea beneath
Normal in infants and asymptomatic

63
Q

List some causes for Blue Sclera

A 
Osteogenesis imperfecta
Marfan's syndrome
Pseudoxanthoma elasticum
Ehlers-Danlos syndrome
Pseudohyperparathyroidism
Van der Hoeve syndrome
Keratoconus and keratoglobus
Buphthalmos
High myopia
Corticossteroid overuse
Melanosis
Nevus of Ota
64
Q

What is Osteogenesis Imperfecta?

A

Inherited permenant blue sclera
Involves ekelton, ear, joints, teeth, skin and eyes
Four clinical presentations with variable inheritance and deafness

65
Q

What are the three mai nsigns of Osteogenesis Imperfecta?

A

Blue sclera
Deafness
Bone fractures

66
Q

What is Melanosis oculi?

A

Congenital bilateral hyperpigmentation of conjunctiva, episclera, sclera, uvea and choroid

67
Q

What is the Nevus of Ota?

A 
"Oculodermal melanocytosis"
Pigmentation of periorbital skin
Can be on lid, lid margin or entire face
Distribution of pigment along opthalmic and maxillary divisions of CN V
Congenital and unilateral
Malignant degeneration
68
Q

What is a Senile Hyaline Plaque?

A

Localized non-inflammatory thinning
Tends to be anterior to insertion of MR and LR muscles
Seen in older population, common, asymptomatic and benign
Can be multiple and diffuse
To treat, reassure patient and monitor

69
Q

What is Icterus/Jaundice?

A

Yellowing of sclera or skin due to high concentration of bilirubin in blood
Need medical exam

70
Q

Describe scleral perforation

A

High veolocity projectiles striking the sclera
Varying degrees of pain
Sight may not be detectable
Associated wit hconjunctivitis, keratitis, uveitis, intraocular heme, lowered IOP or hemosiderosis (rusting in the eye)

71
Q

How do you treat and examine for scleral perforations?

A

Perform gonio, DFE, B-scan, CT scan, DO NOT USE MRI

Treat with immediate hospitalization and Fox shield to protect eyes

Ocular Disease Test 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions