• Sclera posterior 5/6th opaque part of
the external fibrous tunic of the eyeball.
• outer surface }covered by Tenon's capsule.
• anterior part } covered by bulbar conjunctiva.
Its inner surface lies in contact with choroid
potential suprachoroidal space in between
Thickness of sclera.
• thinner }children and in females Sclera
• thickest} posteriorly (1mm)
• gradually becomes thin when traced anteriorly.
• thinnest } insertion of extraocular muscles (0.3 mm).
• Lamina cribrosa is a sieve-like sclera from which fibres of optic nerve
Apertures of sclera
• Anterior ciliary vessels
• four vortex veins (vena verticosae)
• Optic nerve
• Long & short ciliary nerves
Layers of sclera
thin, dense vascularised
layer of connective tissue fibroblasts,
avascular structure dense bundles of
innermost blends with suprachoroidal and
laminae of the uveal tract.
brownish in colour
presence of pigmented cells.
Inflammations of sclera
• Episcleritis (superficial)
• benign recurrent inflammation of the episclera,
• involving the overlying Tenon's capsule
• but not the underlying sclera.
• Associated with gout/psoriasis/rosacea
• Hypersensitivity reaction to endogenous tubercular or streptococcal
• localised lymphocytic infiltration of episcleral tissue
• oedema and congestion of overlying Tenon's capsule and
• by redness,
• mild ocular discomfort described as gritty, burning or
• foreign body sensation
• diffuse episcleritis,
• whole eye maybe involved to
• the maximum inflammation is
confined to one or two
• nodular episcleritis,
• a pink or purple flat nodule
surrounded by injection is seen,
2-3 mm away from the limbus
• The nodule is firm, tender and
the overlying conjunctiva moves
• limited course of 10 days to 3 weeks =resolves spontaneously.
• recurrences common and tend to occur in bouts.
• a fleeting type of disease (episcleritis periodica) may occur
• infiltration by PMNL , lymphocytes, plasma cells and macrophages
• Fibrinoid necrosis, destruction of collagen
• granuloma surrounded by multinucleated epitheloid giant cells
• I. Anterior scleritis (98%)
• 1. Non-necrotizing scleritis (85%)
• (a) Diffuse
• (b) Nodular
• 2. Necrotizing scleritis (13%)
• (a) with inflammation
• (b) without inflammation (scleromalacia perforans)
• II. Posterior scleritis (2%)
• moderate to severe pain
• deep and boring in character and often
• wakes the patient early in the morning .
• radiates to the jaw and temple.
• localised or diffuse redness
• mild to severe photophobia
• 1. Non-necrotizing anterior diffuse scleritis.
• widespread inflammation involving a quadrant or more of the
• The area is raised and salmon pink to purple in colour
• Non-necrotizing anterior nodular scleritis.
• one or two hard, purplish elevated scleral nodules,
• usually situated near the limbus
• the nodules are arranged in a ring around the limbus (annular
• 3. Anterior necrotizing scleritis with inflammation.
• acute severe form of scleritis
• characterised by intense localised inflammation
• associated with areas of infarction due to vasculitis
• necrosed sclera thinned out (sclera becomes transparent and
ectatic) with uveal tissue shining through it.
• Anterior uveitis+
• Anterior necrotizing scleritis without inflammation (scleromalacia
• elderly females with long-standing RA.
• yellowish patch of melting sclera (due to obliteration of arterial
• with overlying episclera andconjunctiva completely separates from
the surrounding normal sclera.
• Eventually absorbs leaving behind it a large punched out area of
• thin sclera through which the uveal tissue shines
• Spontaneous perforation rare
• posterior scleritis.
• the sclera behind the equator.
• frequently misdiagnosed.
• associated inflammation of adjacent structures,
• exudative retinal detachment,
• macular oedema,
• proptosis and
• limitation of ocular movements.
• 1. TLC, DLC and ESR
• 2. Serum levels of complement (C3), immune complexes, rheumatoid
factor, antinuclear antibodies and L.E cells for an immunological
• 3. FTA - ABS, VDRL for syphilis.
• 4. Serum uric acid for gout.
• 5. Urine analysis.
• 6. Mantoux test.
• 7. X-rays of chest, paranasal sinuses, sacroiliac joint and orbit to rule
out foreign body especially in patients with nodular scleritis.
• (A) Non-necrotising scleritis
• Topical steroid eyedrops and
• systemic indomethacin 100 mg daily for a day and then 75 mg daily until
• (B) Necrotising scleritis.
• Topical steroids & heavy doses of oral steroids tapered slowly.
• In non-responsive cases, immuno-suppressive agents like methotrexate or
• Subconjunctival steroids are contraindicated because they may lead to scleral
thinning and perforation
• Ass. With ectasia of cornea & iris
• Due to perforating corneal ulcer & injury
healing of a perforating injury or a peripheral corneal ulcer
to ectasia of weak scar tissue formed at the limbus
localised bulge in limbal area lined by root of iris
• marked corneal astigmatism Defective vision
• 2’angle closure glaucomaprogression of swelling
• localised staphylectomy under heavy doses of oral steroids.
• bulge of weak sclera lined by ciliary body.
• about 2-3 mm away from the limbus
• thinning of sclera following perforating injury,
• scleritis and absolute glaucoma.
• bulge of sclera lined by the choroid in the equatorial region
• at the regions of sclera which are perforated by vortex veins.
• causes= scleritis and degeneration of sclera in pathological myopia
• bulge of weak sclera lined by the choroid behind the.
• common causes are pathological myopia, posterior scleritis and
• Diagnosis ophthalmoscopy.
• The area is excavated with retinal vessels dipping in it (just like
• marked cupping of optic disc in glaucoma)