SCLERITIS presentation dhir hospital bhiwani.pptx

1. SCLERITIS
Presenter : Dr Nikhil Agrawal (2nd year resident)
Moderator : Dr Parikshit Dhir
DHIR HOSPITAL AND POSTGRADUATE INSTITUTE OF OPHTHALMOLOGY

2. ANATOMY
• Avascular
• 5/6th covering : protection
• Maintain shape and IOP
• Attachment for EOM
• Diameter : 22mm
• Thickness
 Behind muscle insertion : 0.3mm
 Around optic nerve : 1mm
 At equator : 0.4-0.5mm
 At limbus: 0.8mm
• Arterial supply
 Anterior ciliary artery
 Posterior ciliary artery (long and short)
• Nerve supply
 Posterior ciliary nerve (long and short)

3. Scleral Inflammation
Episcleritis
Simple Nodular
Scleritis
Anterior
Diffuse Nodular Necrotizing
With
Inflammation
Without
Inflammation
(Scleromalacia
perforans)
Posterior

4. EPISCLERITIS
• Benign inflammation
• Self limiting , recurrent
• Young adults , F>M , B/L : 40%
• Etiology :
Idiopathic : m/c
Systemic disease : Herpes zoster , rosacea , gout ,
syphilis , atopy
• Symptoms : Discomfort , irritation, redness, watering ,
photophobia
 Never causes loss of vision
 Usually do not involves uvea or cornea
• Precipitating factors : Stress , menstruation, ovulation ,
allergies
• Mx: Topical NSAID , mild steroids

5. SCLERITIS
• Incidence : 3-4 case/ 1lac
• F>M , 4-6th decade
• M/C: Anterior , non-necrotizing ,non-infectious
• Infectious scleritis :5-10%
• Systemic disease association : 40-55%(Necrotizing 50-80%)
Auto immune diseases Infectious diseases
Rheumatoid arthritis TB
Wegner's Granulomatosis Syphilis
Inflammatory Bowel Disease Leprosy
SLE Herpes zoster
Relapsing polychondritis Lyme disease
Seronegative spondyloarthropathy Fungal
Polyarthritis nodosa Acanthamoeba

6. Pathogenesis
• Infiltration of inflammatory cells into episcleral and sclera
• Diffuse : Non-granulomatous , perivascular distribution
• Nodular : Granulomatous , vasculitic causing necrosis of vessel wall
Type 2 hypersensitivity : Direct antibody mediated
Type 3 hypersensitivity : Immune complex mediated
Type 4 hypersensitivity : Delayed hypersensitivity

7. Symptoms
• U/l, B/l , recurrent
• Tenderness , Dull pain : Worsen with eye movements , radiating to neck , jaw
• Redness, scleral edema
• DOV : Involvement of cornea or uvea

8. Diffuse Anterior Scleritis
• Do not blanch on putting phenylephrine

9. Nodular Anterior Scleritis
• Syphillis
• Herpes virus

10. Necrotizing Scleritis
• Loss of vision
• Ulceration of sclera , Nodular , thinning
• Uveal tissue visible
• Associated with systemic diseases , surgery
(pterigyum), PUK , stromal keratitis ,
anterior staphyloma ,cataract

11. Posterior Scleritis