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Ocular Disease > Episcleritis/Scleritis > Flashcards

Episcleritis/Scleritis Flashcards

1
Q

What is shown?

A

Nodular Episcleritis

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2
Q

What is this?

A

Diffuse Scleritis

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3
Q

What is this an example of?

A

Scleral Thinning

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4
Q

What is this?

A

Nodular Scleritis

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5
Q

How do the vessels run in the episclera?

A

Straight vessels in a radial configuration

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6
Q

What is this?

A

Scleromalacia Perforans

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7
Q

What is slcera made of?

A

Highly organized collagen, elastin, glycoproteins and proteoglycans

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8
Q

What innervates the sclera?

A

Short and long ciliary nerves

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9
Q

What vessels blanch easily with phenylephrine?

A

Superficial episcleral plexus vessels

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10
Q

Which plexus is most affected in slcleritis?

A

Deeper episcleral plexus

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11
Q

What are the two types of episcleritis?

A

Simple - most common

Nodular

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12
Q

What are the types of slceritis anterior?

A

Non-necrotizing (95%)

  • Diffuse (90%)
  • Nodular (5%)

Necrotizing (5%)

  • w/inflammation
  • w/o inflammation (scleromalacia perforans
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13
Q

2/3 of episcleritis is ___.

A

Idiopathic

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14
Q

When in episcleritis most common?

A

Spring and fall - don’t confuse with allergic conjunctivitis

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15
Q

What is the general presentation of episcleritis?

A

Mild, transient, recurrent, idiopathic inflammation

Often bilateral and sectoral

Symptomes may be none to moderate (some pain from nodular)

Typically sectoral, but may be diffuse

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16
Q

Episcleritis is ___ and generally lasts ___.

A

Self-limiting

2-21 days

Nodular variety takes longer

17
Q

What are the common treatments for episcleritis?

A

Often none

In nodular you may use:

Artificial tears

Topical steroid

Topical NSAID

18
Q

If phenylephrine causes the hyperemia to dissipate, what is the probable disease?

A

Episcleritis

19
Q

What are the signs/symptoms of diffuse episcleritis?

A

Redness followed by aching and pain

-Boring pain may radiate to brow, forehead, ear, jaw and temple

Nocturnal pain wakes patient; improves during day

Redness commonly starts in superior temporal quadrant

Intense red/purple hue with deep plexus injection

*Tender to palpation

Lacrimation, photophobia

*Bliateral 50%

20
Q

At what age does diffuse scleritis usually occur?

A

45-60 , but very rare overall

50% have underlying disease

21
Q

What is seen with scleral thinning?

A

Underlying dark uveal pigment becomes visible

22
Q

Recurrence of ___ scleritis is common.

A

Nodular

23
Q

20% of nodular scleritis may progress to ___.

A

Necrotizing

24
Q

Many patients with nodular scleritis have previously had what?

A

HZV of the eye

25
Q

What signs/symptoms describe nodular scleritis?

A

Insidious onset of pain

Redness, tenderness, nodule

26
Q

Which form of scleritis is the most aggressive?

A

Necrotizing

27
Q

What happens to the sclera with necrotizing scleritis?

A

It becomes transparent

28
Q

What percent of necrotizing scleritis is bilateral?

A

60%

29
Q

Which of the scleritises has the strongest association with systemic disease?

A

Necrotizing

30
Q

What other diagnoses may look like necrotizing scleritis, but aren’t?

A

Malignant melanoma inflammatory syndrome

Squamous cell carcinoma of limbus

31
Q

What disease is associated with:

Discomfort or pain disproportionate to the severity of orbital inflammation

Tender to palpatation

No photophobia

A

Posterior scleritis

32
Q

What are the associated complications with posterior scleritis?

A

Papilledema

Choroidal folds

CME

Retinal heme

Exudative RD

Choroidal effusion

Myositis

Proptosis

33
Q

What are the treatments for anterior scleritis?

A

NSAID (for non-necrotizing)

Systemic steroid if 3 separate rounds of NSAID fails

Immunosuppression if steroids fail, or necrotizing dz

Ocular Disease (4 decks)

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