Download - Sclera 7.4.16 dr.n.swathi
![Page 1: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/1.jpg)
SCLERA
SCLERITISSTAPHYLOMA
![Page 2: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/2.jpg)
Objectives: • Basic anatomy of the sclera.
• Etiology, types & clinical features of episcleritis & scleritis.
• Management of episcleritis & scleritis.
• Define staphyloma.
• Types of staphyloma & their causes.
![Page 3: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/3.jpg)
Collagen bundles
– Varying size
– Varying shape
– Less uniform orientation than cornea
– Inner layer blends with uveal tract
![Page 4: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/4.jpg)
Vascular layers
• Conjunctival vessels – Most superficial
• Superficial Episcleral vessels – Within Tenon’s capsule
• Radial configuration
• Deep Vascular plexus – Lies adjacent to sclera
![Page 5: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/5.jpg)
![Page 6: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/6.jpg)
Episcleritis
![Page 7: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/7.jpg)
Clinical Features:
• Common• Benign• Self-limiting• Recurrent• Never progresses to scleritis• Rarely associated with systemic disease
![Page 8: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/8.jpg)
Classification
• Simple episcleritis – Sectoral redness – Diffuse redness – Resolves in 1-2 weeks
• Nodular episcleritis – Focal, raised, nodular – Sclera uninvolved – Longer to resolve
![Page 9: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/9.jpg)
Management :
Mild cases • Usually no specific Rx• – If discomfort • Lubricant • Topical NSAID eg acular (keterolac) • Mild topical corticosteroid (e.g. Fluconazole)
Recurrent or unresponsive cases
• – Systemic NSAID – e.g. Ibuprofen• – Refer for investigation if 3 or more recurrences
![Page 10: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/10.jpg)
![Page 11: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/11.jpg)
Scleritis
![Page 12: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/12.jpg)
Relatively rare
Granulomatous inflammation
Mild to blinding spectrum
![Page 13: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/13.jpg)
Classification
Anterior Scleritis
Posterior Scleritis
Non-necrotizing
diffuse nodular
Necrotizing
with inflammation
without inflammation
![Page 14: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/14.jpg)
Associated systemic diseases
Rheumatoid Arthritis Connective Tissue Disease - Wegener granulomatosis - Systemic lupus erythematosus - Polyarteritis nodosa Herpes Zoster Ophthalmicus Miscellaneous - Surgically induced - Infectious
![Page 15: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/15.jpg)
Anterior Scleritis: non-necrotizing
1. Diffuse scleritis
• Widespread redness• Sectorial or entire ant. Sclera• Loss of radial vessel pattern of sclera• Does not progress to nodular or necrotizing• Relatively benign
![Page 16: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/16.jpg)
2. Nodular Scleritis
• On initial assessment like episcleritis• Scleral nodule immobile• Tender to palpation
![Page 17: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/17.jpg)
Management:
• Oral NSAID (Ibuprofen)
• Oral Prednisone (if intolerant or unresponsive to NSAIDS)
• Combined therapy
• Immunosuppressives Cyclophosphamide, azathioprine or cyclosporine in steroid resistant cases
Manage in conjunction with a physician
![Page 18: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/18.jpg)
Anterior necrotizing scleritis:with inflammation
• Severe form of disease• Gradual onset• Pain and local redness
![Page 19: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/19.jpg)
Clinical signs
1. Distortion & occlusion of BVs2. Avascular patches in episcleral tissue3. Scleral necrosis4. Underlying uvea visible5. Necrosis spreads, may become confluent6. Anterior uveitis
![Page 20: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/20.jpg)
Treatment
• Oral prednisone 1mg/kg/day Or Pulsed IV Methylprednisolone (500-1000mg)
Monitor pain in first 2-3 days Taper dose of steroids to response• Immunosuppressives Cyclophosphamide, azathioprine or cyclosporine in steroid resistant cases
Manage in conjunction with a physician
![Page 21: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/21.jpg)
Anterior necrotizing scleritis:without inflammation
Scleromalacia perforans
Asymptomatic Mainly in females with longstanding RhA Commences with yellow necrotic scleral patch Large areas of uvea eventually exposed Spontaneous perforation rare No effective treatment
![Page 22: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/22.jpg)
Posterior Scleritis
arising posterior to the equator
• Maculopathy• Optic neuropathy• Exudative retinal detachment
![Page 23: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/23.jpg)
Clinical signs
• External eye– eyelid oedema– proptosis– ophthalmoplegia
• Ophthalmoscopy– Disc swelling– Macular oedema– Exudative retinal detachment
• Other signs– Vitritis– Choroidal folds– Subretinal exudates
![Page 24: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/24.jpg)
Investigations
Ultrasonography : Thickening of choroid & sclera Oedema of Tenons space T-sign No mass lesion
CT scan Fluorescein angiography
![Page 25: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/25.jpg)
Treatment
Elderly patients with systemic disease - treat as necrotizing anterior scleritis
Young patients without systemic disease - treat with NSAIDS
![Page 26: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/26.jpg)
![Page 27: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/27.jpg)
STAPHYLOMA
![Page 28: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/28.jpg)
Ectasia of the outer coats of the eye with incarceration of uveal tissue.
Weakening of the eye wall with raised intraocular pressure
![Page 29: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/29.jpg)
![Page 30: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/30.jpg)
![Page 31: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/31.jpg)
Anterior staphyloma
• Cornea
• Sequelae of corneal ulcer
![Page 32: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/32.jpg)
![Page 33: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/33.jpg)
Intercalary staphyloma
• Upto 8 mm behind limbus
• Incarceration of ciliary body
• Developmental glaucoma• End stage glaucoma (pri / sec)• Scleritis • Trauma to ciliary region
![Page 34: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/34.jpg)
![Page 35: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/35.jpg)
Equatorial staphyloma
• 8-14 mm behind the limbus
• Scleritis• Pathological myopia• Chronic uncontrolled glaucoma
![Page 36: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/36.jpg)
![Page 37: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/37.jpg)
Posterior staphyloma
• Posterior pole of the eye
• Pathological myopia
![Page 38: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/38.jpg)
• Define staphyloma
• Name the different tyes of staphyloma
• Give one common cause for each type of staphyloma
• Give the classification of scleritis
• Any two DD for nodular episcleritis
![Page 39: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/39.jpg)
Suggested reading
• Etiology, clinical features and management of Episcleritis
• Etiology, classification, clinical features and management of Scleritis
• Types & etiology of staphyloma.
• Treatment of anterior scleritis. Ocular complications of the treatment
![Page 40: Sclera 7.4.16 dr.n.swathi](https://reader036.vdocuments.pub/reader036/viewer/2022062522/5880e35b1a28ab0d358b52e3/html5/thumbnails/40.jpg)
Thank you