Episclera and sclera




Episcleritis


Simple episcleritis





  • Diagnosis




    • Presentation: acute onset of redness and mild discomfort.



    • Signs: hyperaemia may be sectoral (typically interpalpebral; Fig. 8.1 ) or diffuse.




      Fig 8.1



    • Course: spontaneous improvement occurs within several days, but recurrences may occur.




  • Treatment: not required if mild; otherwise lubricants or a weak steroid four times daily for 1–2 weeks.



Nodular episcleritis





  • Diagnosis




    • Presentation: less acute onset than simple episcleritis with redness and discomfort worsening over 2–3 days.



    • Signs: (a) one or more tender interpalpebral nodules ( Fig. 8.2 ), and (b) absence of deeper scleral thickening; after several attacks, the vessels surrounding the inflamed area may become permanently dilated.




      Fig 8.2



    • Course: more prolonged than simple episcleritis.




  • Treatment: similar to that of simple episcleritis.





Immune-mediated scleritis


Anterior non-necrotizing scleritis





  • Definition: scleritis involves oedema and cellular infiltration of the entire thickness of the sclera; it is much less common than episcleritis and ranges from a trivial and self-limiting to a necrotizing sight-threatening condition.



  • Diagnosis




    • Presentation: in 5th decade with redness, discomfort, and aching.



    • Diffuse disease: redness; generalized ( Fig. 8.3 ) or localized to one quadrant.




      Fig 8.3



    • Nodular disease: (a) single or multiple scleral nodules, of a deeper blue-red colour than episcleral nodules, and (b) vascular congestion and dilatation with oedema and displacement of the entire beam of the slit lamp ( Fig. 8.4 ).




      Fig 8.4



    • Course: as inflammation settles, the affected area often takes on a slight grey/blue appearance due to increased translucency ( Fig. 8.5 ); episodes recur over several years, with the frequency decreasing after approximately 18 months.




      Fig 8.5



    • Prognosis: usually good, although more than 10% of patients with nodular scleritis develop necrotizing disease if early treatment is not instituted.




Anterior necrotizing scleritis with inflammation



Jul 11, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Episclera and sclera

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