Episclera and Sclera Flashcards
(26 cards)
The Sclera is divided in
episclera
scleral stroma
lamina fusca
The sclera develops from
neural crest and mesoderm
until 5th month
primary component of the sclera
Type I collagen
what is the site of attachment of the ciliary musculature
Scleral spur
site of attachment of EOM
Sclera
Two episcleral Plexus
- Superficial- located in episclera
- Deep Plexus- Located above the scleral stroma
Episcleritis
superficial episcleral plexus congested.
Bening inflammation of the vascular connective tissue sheet between sclera and conjuntiva
- more common idiopathic 60-70%
-young adults
-acute
-unilateral or bilateral
-more in women 3:1 - no pain with eye movement
-Inflammation, fluid can be seen
Scleritis
superficial and deep episcleral plexus congested
-severe moderate pain
-pain with eye movement
Inflammation, not fluid seen
Episclera
loose, Vascularized Connective tissue
1/3 of episcleritis have
underlying Systemic disorders, the rest is related to trauma
Systemic non-infectious causes of episcleritis
- Connective tissue disease
- RA is the #1
-SLE
-IBD - Vasculitic disease
-polyarteritis Nodosa
-Behcet;s disease
-Giant cell arteritis
-Cogans syndrome
Blood supply to the sclera
choroid to sclera
- short post ciliary artery
systemic infectious causes of episcleritis
-bacteria gram + and -
-TB
-syphilis
-Toxoplasmosis
-HZV , HSV
-Acanthamoeba
-Chlamydia
-pseudomonas
Other causes of Episcleritis
-Rosacea
-Atopy
-Thyroid
-Sarcoid
-Burns/ injuries
-Gout
-Medications: Topiramate and Pamidronate
Episcleritis Symptoms
- Acute onset of redness
-mild pain
-one or both eyes
-one or both eyes
-Hx recurrent episodes is common
-No discharge
-tearing
diffuse episcleritis
-80%
-diffuse redness and edema flat
-engorgement of episcleral vessels, large vessels that run in radial direction
Nodular
-20%
-forms a “nodule” (mild elevation of the conjuntiva) composed of localized inflammatory cells and exudates
-Sign: nodule moves
Episcleritis signs
-Mild red flush to intense red
-no edema in sclera
-if nodular, nodules moves
-conjvessels move and underlying red episcleral are immovable
Episcleritis work-up
- phenylephrine test: 10-15 min later will blanch superficial layer
-nodule mobility test in nodular episcleritis ( move with cotton tip- it will move)
scleral edema is present in
scleritis during SLE beam test but absent in episcleritis
Differential diagnosis of episcleritis
-Scleritis: severe pain
-conjuntivitis (viral, bacterial, allergic): discharge follicles or papilla
-phlyctenular Keratoconjuntivitis: plyctena near cornea
- anterior uveitis: cells and flares
Treatment for mild Episcleritis
- self limiting, artificial tears, cold soaks
-Fluorometholone 0.1% (steroids) qid
-may resolve spontaneously 7-10 days
-F/U. 7 days
treatment for moderate to severe episcleritis
Mild steroids qid until improvement and taper
-Fluoromethalone 0.1%
-Loteprednol 0.5%
If not relief:
Oral NSAID
-ibuprofen 200-600mg tid or quid
- Naproxen 250-500mg bid
-Flurbiprofen 100mg tid
F/U 3-5 days
Scleritis
severe intense inflammatory condition with edema and cell infiltration to sclera
