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Ocular Disease > Sclera & Episclera > Flashcards

Sclera & Episclera Flashcards

1
Q

What arteries vascularize the episclera?

A

Long posterior ciliary & anterior ciliary (along recti)

Superficial Conjunctival plexus

Superficial episcleral plexus

The plexi anastomose at limbus forming anterior episcleral arterial circle

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2
Q

What vasculature is affected in scleritis?

A

Deeper episcleral plexus which is adherent to the sclera

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3
Q

Is the sclera vascularized?

A

It is pooly vascularized

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4
Q

What percent of scleritis is non-necrotizing?

A

95%

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5
Q

What percent of episcleritis occurance is idiopathic?

A

2/3

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6
Q

What demographics are more likely to get episcleritis?

A

Female > male

Young and middle aged

No racial predilection

More common in spring and fall

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7
Q

How does episcleritis present?

A

Bilateral

Burning, hot discomfort, gritty, photophobia

Pain more likely in nodular

Acute onset

Typically sectoral but can be diffuse

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8
Q

How do you treat episcleritis?

A

Episcleritis is limiting at about a 21 day course. Nodular episcleritis is on the longer end.

Usually no treatment but may use: Artificial Tears, Topical Steroids, Topical or Oral NSAIDs

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9
Q

Why are topical steroids risky?

A

Rebound

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10
Q
A

Nodular Episcleritis

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11
Q
A

Nodular Episcleritis

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12
Q

What percent of non-necrotizing scleritis is nodular?

A

5%

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13
Q

How does diffuse scleritis present?

A

Redness followed by aching and deep boring pain

Superior temporal quadrant start

Intense redness/purplish hue w/ deep plexus injection

Tender to palpation

Bilateral (50% of time)

Chronic inflammation

Lacrimation, Photophobia

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14
Q
A

Diffuse scleritis

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15
Q

How often is the cornea involved in diffuse scleritis?

A

30%

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16
Q

What is the occurence of diffuse scleritis?

A

Average onset 45-60yo

RARE

No racial or geographic predilection

Female slightly greater than male

50% have underlying systemic dz

17
Q
A

Diffuse Scleritis

18
Q

What happens in scleral thinning?

A

Underlying dark uveal pigment becomes visible

19
Q

What is the second most common form of scleritis?

A

Nodular scleritis; 20-40% of patients

20
Q

What is the occurence of nodular scleritis?

A

Female > male

Recurrence common

Disproportionate number have prior HZV of eye

21
Q

What percent of nodular scleritis progresses to necrotizing?

A

20%

22
Q
A

Nodular Scleritis

23
Q
A

Nodular scleritis; notice displacement of beam over nodule

24
Q

What is the most severe and least common form of scleritis?

A

Necrotizing scleritis

25
Q

What is the presentation and occurence of necrotizing scleritis?

A

Later onset (>60yo)

Female > male

Bilateral 60%

Strongest association with systemic dz

26
Q

What form of scleritis is vision threatening?

A

Necrotizing scleritis

27
Q

What are some diseases that may masquerade as necrotizing scleritis?

A

Malignant melanoma inflammatory syndrome

Squamous cell carcinoma of limbus

If there is an atypical course and it is non-responsive to anti-inflammatory therapy then you should biopsy.

28
Q

What is the presentation of scleromalacia perforans?

A

Non-inflammatory, non-perforating

Older females

Bilateral

Longstanding RA

Arteriolar occlusion

29
Q

What is the treatment for scleromalacia perforans?

A

There is none.

30
Q
A

Non inflammatory Scleromalacia Perforans

31
Q

Why is posterior scleritis so dangerous?

A

Has few anterior signs making it often misdiagnosed

Pain is not as severe as the orbital inflammation looks like it should be

Blindness can occur quickly

32
Q

What are some differentials to posterior scleritis?

A

Orbital mass

Fundus neoplasm

Graves Dz

Hypotony

Scleral buckle

Orbital cellulitis

33
Q

What systemic diseases are most commonly associated with scleritis?

A

Inflammatory bowel dz (18%)

Relapsing polychondritis (40%)

34
Q

How should you treat scleritis?

A

Each treatment should be handled individually and early treatment is important

Must have clearly defined objectives with immunosuppression:

Relief of symptoms

Preservation of vision

Prevention of complications

Prevention of treatment complications

35
Q
A

Peripheral ulcertive keratitis

Ocular Disease (7 decks)

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