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Scleritis and episcleritis
- 1. SCLERITIS AND EPISCLERITIS ANAKHA RAJENDRAN ROLL NO:23
- 2. ANATOMY OF SCLERA POSTERIOR 5/6TH OF EYEBALL OUTER SURFACE COVERED BY TENONS CAPULE AND BULBAR CONJUNCTIVA ANTERIORLY INNER SURFACE LIES IN CONTACT WITH CHOROID AND SUPRACHOROIDAL SPACE GENERALLY THINNER IN CHILDREN AND IN FEMALES THINNEST AT INSERTION OF EOM
- 3. APERTURES OF SCLERA • Anterior • Anterior ciliary vessels • Middle • four vortex veins (vena verticosae) • Posterior • Optic nerve • Long & short ciliary nerves
- 4. HISTOLOGICALLY,3 LAYERS: EPISCLERAL TISSUE-THIN,DENSE VASCULARISED,AND FIBROBLASTS,MACROPHAGES,LYMPHOCYTES SCLERA PROPER-AVASCULAR,DENSE BUNDLES OF COLLAGEN LAMINA FUSCA-INNERMOST PART AND BLENDS WITH SUPRACHOROIDAL AND SUPRACILIARY LAMINA OF UVEAL TRACT.BROWNISH IN COLOUR DUE TO PRESENCE OF PIGMENTED CELLS
- 5. CLASSIFICATION EPISCLERITIS SIMPLE NODULAR SCLERITIS ANTERIOR-NON NECROTISING :DIFFUSE NODULAR NECROTISING:WITH INFLAMMATION WITHOUT INFLAMMATION POSTERIOR
- 6. EPISCLERITIS BENIGN RECURRENT INFLAMMATION OF EPISCLERA INVOLVE TENONS CAPSULE NOT SCLERA PROPER AFFECTS MORE YOUNG ADULTS AND FEMALES
- 7. ETIOLOGY IDIOPATHIC-MOST CASES SYSTEMIC DISEASES-GOUT,PSORIASIS,CONNECTIVE TISSUE DISEASES HYPERSENSITIVITY REACTION-TB AND STREP PROTEINS INFECTIONS-HERPES ZOSTER VIRUS,SYPHILIS,LYMES DISEASE,TB
- 8. CLINICAL FEATURES SYMPTOMS REDNESS,MILD OCULAR DISCOMFORT AS GRITTY,BURNING AND FB SENSATION MILD PHOTOPHOBIA AND LACRIMATION-RARELY
- 9. SIGNS 2 TYPES:SIMPLE AND NODULAR SIMPLE:SECTORIAL INVOLVEMENT OF EPISCLERA AND ENGORGED EPISCLERAL VESSELS RUN RADIALLY NODULAR:PINK OR PURPLE FLAT NODULE SURROUNDED BY INJECTION FIRM,TENDER,MOVED SEPERATELY FROM SCLERA
- 12. DIFFERENTIAL DIAGNOSIS SIMPLE EPISCLERITIS:CONJUNCTIVITIS NODULAR:INFLAMED PINGUECULA,SWELLING AND CONGESTION DUE TO FOREIGN BODY AND SCLERITIS
- 13. TREATMENT TOPICAL ARTIFICIAL TEARS TOPICAL NSAIDS SYSTEMIC NSAIDS TOPICAL MILD CORTICOSTEROID EYEDROPS COLD COMPRESSES
- 14. SCLERITIS CHRONIC INFLAMMATION OF SCLERA PROPER SERIOUS DISEASE AS IT CAN CAUSE VISUAL IMPAIRMENT AND LOSS OF EYE MOSTLY SEEN IN ELDERLY 40-70 AND FEMALES
- 15. ETIOLOGY IDIOPATHIC AUTOIMMUNE COLLAGEN DISORDERS METABOLIC DISORDERS GRANULOMATOUS DISEASES INFECTIONS SURGICALLY INDUCED MISCELLANEOUS CONDITIONS
- 16. HISTOPATHOLOGY CHRONIC GRANULOMATOUS DISORDER FIBRINOID NECROSIS DESTRUCTION OF COLLAGEN WITH INFILTRATION
- 17. CLINICAL FEATURES PAIN-MODERATE TO SEVERE,DEEP,BORING,WAKES PATIENT IN MORNING AND PAIN IS RADIATED TO JAW AND TEMPLE REDNESS-LOCALISED OR DIFFUSE PHOTOHOBIA AND LACRIMATION-MILD TO MODERATE DIMINUTION OF VISION
- 18. SIGNS NON NECROTISING ANTERIOR DIFFUSE-INVOLVED AREA IS RAISED AND SALMON PINK TO PURPLE IN COLOUR NON NECROTISING ANTERIOR NODULAR-ONE OR TWO HARD PURPLISH ELEVATED IMMOVABLE USUALLY NEAR LIMBUS SOMETIMES AS RING SCLERITIS
- 20. ANTERIOR NECROTISING WITH INFLAMMATION-ACUTE SEVERE FORM,INTENSE LOCALISED INFLAMMATION,AREAS OF INFARCTION DUE TO VASCULITIS.NECROSED AREA THINNED OUT SCLERA TRANSPARENT AND TISSUE SHINE THROUH IT WITHOUT INFLAMMATION-ELDERLY FEMALES,LONG STANDING RA.YELLOWISH PATCH OF MELTING SCLERA WHICH IS DEAD WHITE IN COLOUR,AND LARGE PUNCHED OUT AREAS OF THIN SCLERA THROUGH UVEAL TISSUE SHINESS POSTERIOR-INFLAMMATION BEHIND EQUATOR
- 22. COMPLICATIONS SCLEROSING KERATITIS KERATOLYSIS COMPLICATED CATARACT SECONDARY GLAUCOMA
- 23. INVESTIGATIONS TLC,DLC,ESR SERUM COMPLEMENT LEVELS,RF,ANA,LE CELLS FTA-ABS,VDRL SERUM URIC ACIS FOR GOUT URINE ANALYSIS MANTOUX TEST X-RAY CHEST,PNS,SACROILIAC JOINT AND ORBIT
- 24. TREATMENT NON NECROTISING-TOPICAL STEROID EYE DROPS AND SYSTEMIC INDOMETHACIN 75 MG TWICE A DAYUNTIL INFLAMMATION RESOLVES NECROTISING-TOPICAL AND ORAL STEROIDS IN HEAVY DOSES RE GIVEN IF NON RESPONSIVE,MTX OR CYCLOPHOSPHAMIDE SUB CONJUNCTIVAL STEROIDS C/I-LEAD TO SCLERAL THINNING AND PERFORATION