Scleritis and episcleritis

Question 1

Scleral anatomy

Answer 1

Episclera tissue
Sclera proper
Lamina fusca

Question 2

Vascular layers overlying sclera

Answer 2

Conjunctival vessels
Superficial episcleral vessels
Deep vascular plexus

Question 3

Episcleritis

Description

Answer 3

Benign, recurrent and idiopathic non-infective inflammation involving episclera

Question 4

Episcleritis

Types

Answer 4

Simple

Nodular

Question 5

Simple episcleritis

Causes

Answer 5

95% IgE
5% TB, autoimmune
Rarely assoc w systemic disease

Question 6

Anterior scleritis

Answer 6

Non-necrotising
Necrotising
Scleromalacia perforans

Question 7

Non-necrotising anterior scleritis

Answer 7

Diffuse

Nodular

Question 8

Necrotising anterior scleritis

Answer 8

Vaso-occlusive
Granulomatous
Surgically-induced

Question 9

Scleromalacia perforans

Answer 9

Necrotic plaque

Tx is perforation repair

Question 10

Posterior scleritis

Answer 10

Serious, potentially blinding condition <40yo
35% bilateral
Presents with discomfort/pain (sever w orbital myositis), tenderness to palpation

Question 11

Infectious scleritis

Answer 11

Herpes zoster
TB
Leprosy
Syphilis
Lyme disease
Fungi
Pseudomonas
Nocardia

Question 12

TB scleritis

Answer 12

Nodular vs necrotising

Spread:
Direct (choroidal, conjunctival lesion)
Haematogenous

Question 13

Herpes zoster scleritis

Answer 13

Extremely resistant to tx

Punched out/thin scleral patch

Question 14

Leprosy

Answer 14

Lepromatous leprosy - nodular scleritis
Severe recurrent reactions - diffuse scleritis
Necrosis due to scleral infx or immune response

Question 15

Syphilis

Answer 15

Secondary - diffuse ant scleritis

Tertiary - nodular scleritis

Question 16

Lyme disease

Answer 16

Scleritis common but long after initial infection

Question 17

Differentiate between scleritis and episcleritis

Answer 17

Use of adrenaline (epinephrine) drops

Episcleritis vessels will blanche - vasoconstriction