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Episcleritis and scleritis
- 1. EPISCLERITIS AND SCLERITIS ANUSREE.K FINAL YEAR MBBS KANNUR MEDICAL COLLEGE KERALA Email id:anusreeyz@gmail.com
- 2. SCLERA
- 3. STRONG OPAQUE WHITISH FIBROUS 5/6 of external tunic of eye ball TENONS CAPSULE
- 5. 0.66mm
- 7. APERTURES ANTERIOR Anterior ciliary arteries Episcleral veins POSTERIOR Vortex veins Posterior ciliary nerves and vessels Optic nerve
- 9. FUNCTIONS PROTECTION OF EYEBALL OPTICAL SHAPE OF RETINA AND CHOROID INSERTION OF EXTRAOCULAR MUSCLES
- 10. 5.5mm 6.9mm 6.5mm 7.7mm MEDIAL RECTUS LATERAL RECTUS SUPERIOR RECTUS INFERIOR RECTUS
- 11. LAYERS OF SCLERA EPISCLERA SCLERA LAMINA FUSCA FIBROBLAST MACROPHAGES LYMPHOCYTES VASCULAR COLLAGEN ELASTIN AVASCULAR PIGMENTED CELLS BROWNISH
- 12. LAMINA FUSCA EPISCLERA SCLERA SUPERFICIAL EPISCLERAL VESSELS DEEP EPISCLERAL VESSELS CONJUNCTIVA TENONS CAPSULE
- 13. CONJUNCTIVA SCLERA INFLAMMATION EPISCLERA SCLERA SUPERFICIAL EPISCLERAL VESSELS DEEP EPISCLERAL VESSELS CONJUNCTIVA TENONS CAPSULE Inflammation of connective tissue between sclera and conjunctiva EPISCLERITIS
- 14. AETIOLOGY Allergic reaction to endogenous toxin Collagen disease Associated with prior episodes of herpes zoster and gout
- 15. SYMPTOMS Young adults Redness Mild/no pain Tenderness History of recurrent episodes
- 18. WELL CIRCUMSCRIBED DENSE LEUCOCYTE INFILTRATION LENTIL 2-3 mm FROM LIMBUS LITTLE OR NO PAIN DISCOMFORT HARD MORE SYMPTOMATIC TAKES LONGER TO RESSOLVE TENDERIMMOVABLE PURPLE TEMPORAL PERIODICA FUGAX
- 21. TREATMENT MILD Lubricants MODERATE TO SEVERE Mild topical steroid FLUOROMETHOLONE 4 times a day Relieve discomfort and inflammation Oral non steroidal anti inflammatory drugs IBUPROFEN 400mg orally 3-4 times a day ASPIRIN/INDOMETHACIN Taken with food or antacids Review after several weeks Reviewed weekly Check for steroid induced complications Rise in IOP Topical steroids unsuccessful
- 22. SCLERITIS Dense lymphocytic infiltration deep within the scleral tissue BILATERAL CONNECTIVE TISSUE DISEASE-50%
- 23. SYSTEMIC DISEASES Polyarteritis nodosa SLE RA Reiter syndrome Ankylosing spondylitis Non-specific arteritis Wegener granulomatosis Dermatomyosis Polychondritis Gout
- 24. OTHERS Previous attack of herpes zoster ophthalmicus Syphilis Recent ocular surgery Cataract extraction Retinal detachment surgery
- 25. SYMPTOMS PAIN REDNESS DISCHARGE WATERING BLUISH OR BROWNISH DISCOLOURATION
- 26. ANTERIOR SCLERITIS POSTERIOR SCLERITIS DIFFUSE NODULAR NECROTIZING WITH INFLAMMATION WITHOUT INFLAMMATION
- 27. DIFFUSE Hard whitish nodules Size of pin’s head Involvement of cornea and uveal tract Iritis Cyclitis Anterior choroiditis Thinning of sclera cicatrisation Disappear without disintegrating
- 28. Extend to cornea-SCLEROSING KERATITIS Triangular/tongue shaped Rounded apex towards centre of cornea Bluish and cloudy No ulceration No vascularization Can lead to keratolysis
- 29. NODULAR One or more nodules Less circumscribed than episcleritis First dark red or bluish, then purple and semitransparent(porcelain like) Extend entirely around cornea- annular sclerotic
- 30. NECROTIZING SCLERITIS WITH INFLAMMATION WITHOUT INFLAMMATION REDNESS PAIN PART OF SYSTEMIC AUTOIMMUNE DISEASE SCLERAL THINNING COMPLICATIONS Glaucoma Cataract Sclerosing keratitis Peripheral corneal melting Scleromalacia perforans PAINLESS SEROPOSITIVE RA SCLERAL THINNING DAMAGE BLOOD VESSELS ISCHAEMIA NECROSIS
- 32. Thinned sclera Cannot withstand IOP Ectasia Ciliary staphyloma
- 33. INFLAMMATORY CELLS BLOCK EPISCLERAL VEINS INCREASE EPISCLERAL VENOUS PRESSURE INCREASE IOPCORTICOSTEROID USE
- 34. UVEITIS CLOGGING OF TRABECULAR MESHWORK WITH INFLAMMATORY CELLS ANGLE CLOSURE ANGLE CLOSURE GLAUCOMA
- 35. POSTERIOR SCLERITIS Inflammation with thickening of posterior sclera Primary or extension from anterior sclera Diagnosis is easily missed Decreased vision with or without pain Proptosis Restricted ocular movements Choroidal detachment Choroidal folds Disc oedema Macular oedema Exudative retinal detachment B-scan ultrasonography CT scanning
- 36. DIAGNOSIS Total blood count RA latex agglutination test Mantoux test Antinuclear antibody Treponema pallidum immobilization test X-ray chest and sacroiliac joints INVESTIGATIONS HISTORY TAKING SYSTEMIC EXAMINATION
- 37. TREATMENT DIFFUSE AND NODULAR SCLEROSIS Oral NSAID’s Oral PREDNISOLONE Single dose in morning for 1 week 20mg/day for subsequent 2-3 weeks Immunosuppressive agents CYCLOPHOSPHAMIDE METHOTREXATE CYCLOSPORIN AZATHIOPRINE
- 38. NECROTIZING SCLERITIS Systemic STEROIDS IMMUNOSUPPRESSIVES SCLEROMALACIA PERFORANS LUBRICANTS POSTERIOR SCLERITIS Systemic NSAID’s STEROIDS IMMUNOSUPPRESSIVE THERAPY
- 39. EPISCLERITIS SCLERITIS INFLAMMATION INFLAMMATION WITH NECROSIS LESS PAINFULL SEVERE PAIN BLANCHES WITH PHENYLEPHRINE NO BLANCHING DOES NOT CAUSE DAMAGE TO GLOBE CAUSE SCLERAL THINNING LEUCOCYTIC INFILTRATION LYMPHOCYTIC INFILTRATION EPISCLERA SCLERA SECONDARY GLAUCOMA IS ABSENT SECONDARY GLAUCOMA
- 40. Thank you…