Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ocular Disease > Episclera and Sclera > Flashcards

Episclera and Sclera Flashcards

1
Q

what is the episclera made up of?

A

loose, fibrous elastic tissue (collagen) that contains blood vessels that nourish sclera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how is the episclera connected to the sclera?

A

by fascia bulbi (tenon’s capsule)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

who typically gets episcleritis and how does it present?

A

mainly in females (20-40 years old), unilateral, benign (stress/hormonal changes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the signs of episcleritis?

A

cornea is typically unaffected, anterior chamber is deep and quiet, sectoral redness/inflammation and mild edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the symptoms of episcleritis?

A

range from mild-moderate: “feels hot” or uncomfortable, some tenderness on palpation, photophobia, mild tearing, acute onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the two types of episcleritis?

A

simple (80%) and nodular (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is simple episcleritis?

A

diffuse or sectoral inflammation (usually more sectoral) - without nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is nodular episcleritis?

A

discrete elevated area of inflamed episcleral tissue (more painful, prolonged 2-3 months and moveable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some differential diagnoses for episcleritis?

A

conjunctivitis, scleritis, pinguecula/pterygium, phlyctennular conjunctivits or direct trauma (mechanical or chemical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what happens when you perform a 2.5% phenylephrine test?

A

the drop will blanch or vasoconstrict the superficial vessels - if that happens you know it is episcleritis not scleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what causes episcleritis?

A

70% is idiopathic - connective tissue/vascular disease, infectious disease (herpes simplex or zoster, syphilis, lyme), dermatologic (rosacea), or atopic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is some important patient education for episcleritis?

A

duration of treatment - can last up to 2-3 weeks and nodular can be 2-3 months there can be a recurrence up to 3-4 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how do you treat mild cases of episcleritis?

A

topical vasoconstrictors/antihistamines (2-3 weeks) = Visine, Naphcon-A (be careful for rebound hyperemia)

Topical NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how do you treat moderate to severe cases of episcleritis?

A

topical steroids (q1-2 hours QID) = Alrex, FML, prednisolone acetate need to monitor IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some oral NSAIDs used for episcleritis?

A

ibuprofen (800mg TID), Naproxen (250mg BID), and Indomethacin (25mg TID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the sclera made of?

A

white, opaque, dense irregular collagen fibrous tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is scleritis?

A

chronic, painful (severe stabbing pain), and potentially blinding inflammatory disease - rare condition that is typically associated with a systemic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what characterizes scleritis?

A

edema and cellular infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

who does scleritis typically affect and how does it present?

A

females over age 40

50% bilateral with unilateral presentations becoming bilateral in 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are some signs of scleritis?

A

sclera will have a bluish hue, vessels become engorged and tortuous, edema, peripheral cornea can become involved and anterior uveitis can be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are some symptoms of scleritis?

A

severe boring pain that radiates to forehead, brow, jaw and can wake patient up at night, gradual onset, inflammation, tearing/photophobia, decrease in VA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the 3 inflammatory types of anterior scleritis?

A

diffuse (90%), nodular (5%) and necrotizing (5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the 1 non-inflammatory type of scleritis and what is it?

A

scleromalacia perforans = necrosis of sclera without inflammation or ocular pain, due to arteriolar occlusion (usually elderly females with RA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is diffuse anterior scleritis?

A

most common form - doesn’t blanch with 2.5% phenylephrine, non-granulomatous inflammatory reaction, recurrence is common and has corneal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is nodular anterior scleritis?

A

single or multiple nodules, tends to occur in same site (superior sclera), nodules at limbus can raise IOP, associated with RA nodules in 1/3 of cases

26
Q

what is necrotizing anterior scleritis?

A

most severe form - always associated with systemic disease, areas of necrotic scleral tissue, more than 60% develop complications other than scleral thinning, 40% vision loss

27
Q

what are the signs of posterior scleritis?

A

only presents with a few signs unless the anterior segment is also involved - subretinal granuloma, exudative retinal detachment, proptosis, or rapid onset hyperopia

28
Q

what are some symptoms of posterior scleritis?

A

poor/decreased vision, diplopia, severe pain and proptosis

29
Q

what will you see on a DFE with posterior scleritis?

A

papilledema, choroidal folds, CME, retinal hemorrhage or detachment

30
Q

how do you diagnose posterior scleritis?

A

B-scan ultrasound

31
Q

what is the etiology of scleritis?

A

43% may occur in isolation or in association with: autoimmune (50%), infectious (7%), or miscellaneous (2%)

32
Q

what are some autoimmune causes of scleritis?

A

connective tissue disease = RA, lupus

CRAP = chrohns, reactive arthritis (Reiter’s), ankylosing spondylitis, and psoriatic arthritis, gout

Vasculitis diseases = polyarteritis nodosa, wegener granulomatosis, behcet disease, giant cell arteritis

33
Q

what are some infectious disease causes of scleritis?

A

bacterial, fungal, viral or parasitis (herpes zoster, simplex, syphilis, and lyme)

34
Q

what are some miscellaneous causes of scleritis?

A

rosacea, atopy, secondary to FB, chemical injuries or drugs

35
Q

what are some other ocular complications that can occur with scleritis?

A

uveitis (usually with necrotizing), keratitis, glaucoma, cataract (PSC), retinal changes (CME, ONH edema, RD, choroidal folds)

36
Q

what is the initial treatment for diffuse/nodular scleritis?

A

oral NSAIDs = ibuprofen, indomethacin, naproxen (contraindications = peptic ulcer, recent GI bleed, renal insufficiency)

37
Q

what is the treatment if oral NSAIDs aren’t working or scleritis is severe/necrotizing?

A

oral corticosteroids = prednisone (1mg QD or 60-100mg) use with antacid or H2 blocker

38
Q

what do you use for scleritis if oral corticosteroids aren’t working or patient has systemic vasculitis/necrotizing?

A

immunosuppressive drugs = methotrexate, cyclophosphamide (supplemented with oral steroids)

39
Q

what type of steroid should not be given for necrotizing scleritis or peripheral ulcerative keratitis?

A

periocular steroid injections or topical steroids

40
Q

what type of surgery can be performed for scleritis?

A

scleral grafts

41
Q

can scleritis cause episcleritis?

A

yes - but not the other way around

42
Q

what is thinning/extasia?

A

bulging of uveal tissue thru thinning sclera (anterior = inflammation and posterior = high myopia)

43
Q

what is icteric sclera?

A

typically bilateral yellow discoloration to sclera - indication of acute or chronic liver disease (high concentration of bilirubin in blood)

44
Q

what can icteric sclera be an indication of in adults and infants?

A

adults = inflammation/infection, cancer, alcoholism

infants = physiologic, related to breastmilk

45
Q

what is blue sclera?

A

an increase in melanin (nevus of ota) - common in infants, hallmark sign for osteogenesis imperfecta and other connective tissue disorders (Marfans, ehler’s, danlos)

46
Q

what is an axenfeld loop?

A

posterior ciliary nerve that has pierced the sclera - usually adjacent to limbus

47
Q

what is ocular melanosis (complexion-related)?

A

benign - increased pigmentation of basal epithelial cells, pigmentation because lighter as you move peripherally

48
Q

what are hyaline plaques?

A

common in older patients - no symptoms (consider scleromalacia perfomans if overlying tissue is intact)

49
Q

what is ocular melanosis (primary acquired)?

A

an increase in number of melanocytes, unilateral flat patch of pigment seen in middle-aged patients (46% can progress to melanoma)

50
Q
A

blue sclera

51
Q
A

thinning/ectasia

52
Q
A

icteric sclera

53
Q
A

Episcleritis

54
Q
A

Hyaline plaque

55
Q
A

Ocular Melanosis

56
Q
A

nodular episcleritis

57
Q
A

Scleritis

58
Q
A

nodular scleritis

59
Q
A

necrotizing scleritis

60
Q
A

Scleromalacia perfoans

Ocular Disease (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions