anatomy of sclera , anterior sclerits ,epi sclertisi staphylom a

2. DISEASE OF THE SCLERA
Dr. Abdul Basir safi
Lecturer of Nangrahar Medical
faculty
head of eye department
YouTub: Dr Abdul Basir Safi
E-mail: basirsafi123@yahoo.com

3. ANATOMY OF THE SCLERA
• Fibrous layer
• 5/6 of eye ball cover
• Non transference
• EOM insertion

4. Scleral Disease Classifications
1. Episcleritis
2. Scleritis

5. Inflammation of sub conjunctival and
episcleral tissue
Types:
1. Simple diffuse episcleritis
2. Nodular episcleritis
Treatment：
• Self-limiting
• Corticosteroids:
• Eye drop
• Sub cunjuncteval
• NSAIDs: Nevafenac
• Diclofenac sodium
Episcleritis

6. Scleritis
Definition :
• Inflammation of sclera
• Severe than episcleritis
• Young and mid-age adults
• Female>Male
• Autoimmune disease
• Complicated with general collagenous,
• granulomatous
• metabolic diseases

7. pathogeny：
1. Exogenes: Allergic reaction
2. Endogens: Auto immune disease
3. connective tissue diseases
4. Metabolic diseases
5. Other：infection spread, inflammation
spreads in the vicinity of the organization.
Etiology

8. SCLERITIS
•
1. Anterior scleritis
•diffuse scleritis
•Nodular scleritis
• Necrotizing with inflammation
Necrotizing without inflammation
( scleromalacia )
2. Posterior scleritis

9. 1. anterior Scleritis:
disease site： anterior equator， bilateral eyes
current successively。
clinical manifestations ：pain, Vision decrease 、
sclera focus
course：long、recurrent、deferment
prognosis：not good
Complications:：
Uveitis.
Keratitis.
Secondary glaucoma e.g。

10. A: diffuse anterior scleritis
• about 40％
prognosis preferably
• sclera diffuse. redness
• bulbar conjunctiva edema

11. Localized nodule which can be
moved over sclera
Deep scleral part of
slit-beam not displaced
B: nodular anterior scleritis

12. C: necrotizing anterior scleritis
• Vision decrease ，about 14％
• pain，Rapid development
• occlusive vasculitis，sclera necrosis
• dark nodule
• perforated scleromalacia Serious

13. Anterior necrotizing scleritis with
inflammation
Progression
•Complications - uveitis, keratitis, cataract
•and glaucoma
Scleral necrosis and
visibility of uvea
Spread and coalescence
of necrosisAvascular patches
Painful and most severe type

14. •Asymptomatic and untreatable
•Associated with rheumatoid arthritis
Progressive scleral thinning with exposure of underlying uvea
Anterior necrotizing scleritis with
Inflammation (scleromalacia perforans)

15. 2 . Posterior Scleritis:
disease site ： Posterior equator ，about
2-5％
clinical manifestations ：pain，eyelid
and bulbar conjunctiva edema ，eyeball
slightly Prominent， extraocular
involved。 posterior Uveitis 、Vitreous
opacities e.g
diagnoses：Examinations，such as B
Scan、CT、MRI, show Posterior sclera
thickening
different diagnoses ：Orbital cellulitis，

16. Posterior scleritis
Signs
•
Choroidal folds Subretinal exudation
Proptosis and
ophthalmoplegia
Disc swelling Exudative retinal
detachment
Ring choroidal
detachment

17. Imaging in posterior scleritis
Ultrasound
a - Thickening of posterior
sclera
Axial CT
Posterior scleral thickening
a
b

18. Treatment Scleritis
• Symptomatic treatment:：Artificial tears
• Anti-inflammatory treatment：corticosteroids
、Immunosuppressant e.g
• Surgical treatment：necrosis、perporative
Scleral site can be done with Allogeneic
scleral graft
• Complications treatment ：glaucoma、
Iridocylitis, retinal detachment, vitrous
opacity

19. Sclera staphyloma
• definition：
Because of thinning of the sclera，sclera and deep uveal
bulge and expand outward with the function of intraocular
pressure ,and revealed blue-black color of uveal color。
• Classification ：
1. anterior sclera staphyloma
2. equatorial sclera staphyloma
3. posterior sclera staphyloma

20. • treatment：
1. Decompression early
2. If the eyes no light
perception，And pain，
eyes can be removed
( inoculation )

21. Abnormal scleral color
• Scleral pigment plaques：brown or blue-gray spots
currented at anterior sclera surface and entrance of
Ciliary vessels。Scleral melanosis syndrome。
• Blue sclera：It is caused by Uveal color under
sclera because of thin sclera 。concurrent congenital
anomalies
• Sclera yellow Stained：
• Jaundice
• Brown macular : Brown-gray
• spots at sclera，No clinical
• significance。

22. ‫پوښتنی‬‫؟‬