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Sclera
- 2. Anatomy
- 3. Scleral layer • Tenon capsule : contain elastic tissue and collagenous fibers . From limbus to optic nerve • Episclera : vascular layer . In the presence of inflammation this becomes very red and congested (Episcleritis). Becomes thinner toward the back of the eye • sclera proper : collagen ꟾ and proteoglycans • Lamina fusca : innermost part of sclera . Brown because of melanocytes . Contain collagen and fibroblast and melanocyte. Separated from choroid by perchoroidal space
- 7. Special regions of Sclera • Scleral sulcus : a furrow on inner surface of ant point of sclera . It houses Schlemm's canal • Scleral spur : circular rim in anterior part of sclera lying deep to Schlemm's canal /a protrusion of the sclera into the anterior chamber. • Lamina cribrosa : optic nerve passes throw it
- 10. Nerve supply to sclera • Anterior part : long ciliary nerve • Posterior part : short ciliary nerve
- 11. Blue sclera • Buphthalmia • High myopia • Osteogenesis imperfecta • Thinning of sclera like as necrotizing scleritis • Marfan’s syndrome
- 12. Episcleritis • Inflammation of episcleral layer • Clinical manifestation : Red eye , redness disappear after utilization of phenylephrine drop , foreign body sensation • No affect on visual acuity • 2 types : Diffuse . Nodular
- 14. Treatment of episcleritis • Resolve spontaneously • Systemic evaluation is not recommended except in recurrency • Cold compress • Topical and systemic NSAID (indomethacin 250 TDS or flurbiprofen 300 qd) • Topical corticosteroid
- 15. Scleritis • Inflammation of scleral proper • Female > male • 50% bilateral • 2 types : anterior (98%) , posterior
- 16. Symptoms and sign • Pain • Redness • lacrimation • Photophobia • Diminution of vision • If redness disappear after phenylephrine drop is episcleritis but if still persist then scleritis
- 17. Classification
- 20. Necrotizing scleritis with inflammation
- 22. Scleromalacia performance • Elderly females with long standing RA • Thin sclera through which the uveal tissue shines • Spontaneous perforation rare • If IOP increased then create anterior staphyloma
- 23. Posterior scleritis • Diagnosis is difficult • Pain and diminution of vision • Associated with RA or systemic vasculitis
- 25. Lab test • CBC , ESR , ANA , RF , ANCA • Ig , serum proteins • Uric Acid • PPD • VDRL , FTA-ABS • CXR for sarcoidosis , Wegener , TB • Paranasal sinus CT for Wegener • Lumbosacral and SIJ xray for AS • fluorescein angiography