Sclera/Episclera

Question 1

What is the sclera

Answer 1

• outer tough shell of the eye
• protects delicate structures
• anteriorly comes cornea
• thickest at optic nerve

Question 2

Characteristics of Episcleritis

Answer 2

• idiopathic
• benign
• bilateral
• lasts from few days to few weeks
• can be associated with systemic disease

Question 3

What is simple episcleritis

Answer 3

• accounts for 75% of cases
• tends to recur

Question 4

Simple episcleritis symptoms/signs

Answer 4

Symptoms
- discomfort
- grittiness and photophobia

Signs
- normal VA
- redness may be sectoral

Question 5

Simple episcleritis treatment

Answer 5

• if mild, no treatment
• cool compress or refrigerated artificial tears may be helpful
• weak topical steroid four times daily for 1-2 weeks

Question 6

What is nodular episcleritis

Answer 6

• characterized by a discrete, elevated area of inflamed episcleral tissue

Question 7

Nodular episcleritis symptoms/signs

Answer 7

Symptoms
- red eye
- over few days, area of redness enlarges and becomes more uncomfortable

Signs
- lasts longer than simple episcleritis
- tender red vascular nodule
- often more than 1 nodule
- SL shows underlying flat anterior sclera surface
- elevated IOP
- AC reaction

Question 8

Nodular episcleritis treatment

Answer 8

Similar to simple episcleritis

Question 9

What is Immune mediated scleritis

Answer 9

• characterised by oedema and cellular infiltration of the entire thickness of the sclera
• immune mediated is the most common type
• associated with underlying inflammatory condition

Question 10

Scleritis symptoms

Answer 10

• pain, tearing or photophobia
• ocular tenderness
• decreased VA
• exacerbated by touch

Question 11

Types of non-necrotizing scleritis

Answer 11

• diffuse
• nodular

Question 12

What is diffuse anterior non-necrotising scleritis, and what are the signs and symptoms

Answer 12

More common than nodular

Symptoms
- ocular redness
- progresses to pain that radiates to face and temple
- vision may be blurred

Signs
- vascular congestion and dilation associated with oedema
- redness may be generalised or localised to one quadrant
- as oedema resolved, affected area takes on grey/blue appearance due to increased sclera translucency

Question 13

What is nodular anterior non-necrotising scleritis, symptoms/signs

Answer 13

Symptoms
- incidious onset of pain followed by increasing redness, tenderness of the globe and appearance of a scleral nodule

Signs
- nodules may be single or numerous (nodules have a deeper red/blue colour than in episcleritis)
- multiple nodules may expand and coalesce if treatment is delayed
- as inflammation subsides,

Question 14

Treatment of immune mediated scleritis

Answer 14

• topical steroids - relive sx + oedema
• systemic NSAIDs
• systemic steroids - when NSAIDs inappropriate (e.g. presnisolone)