Episclera and Sclera

Episcleritis

Simple episcleritis

Diagnosis

  • ◾

    Presentation : acute onset of redness and mild discomfort.

  • ◾

    Signs : hyperaemia may be sectoral (typically interpalpebral; Fig. 9.1A ) or diffuse.

    Fig. 9.1
    Episcleritis: (A) simple sectoral, (B) nodular.
    (From Salmon JF, Kanski’s Clinical Ophthalmology: A Systematic Approach , 9th edition. Oxford, UK: Elsevier; 2020.)

  • ◾

    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. 9.1B ) and (b) absence of deeper scleral thickening. After several attacks, the vessels surrounding the inflamed area may become permanently dilated.

  • ◾

    Course : more prolonged than simple episcleritis.

Treatment:

similar to that of simple episcleritis.

Immune-mediated scleritis

Anterior non-necrotizing scleritis

Definition:

scleritis is inflammation of the entire thickness of the sclera and results in oedema and cellular infiltration. It is much less common than episcleritis and ranges from a mild and self-limiting inflammation to a necrotizing sight-threatening condition.

Diagnosis

  • ◾

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

  • ◾

    Diffuse disease : redness; generalized ( Fig. 9.2A ) or localized to one quadrant.

    Fig. 9.2
    Anterior non-necrotizing scleritis: (A) diffuse, (B) nodular.
    (From Salmon JF, Kanski’s Clinical Ophthalmology: A Systematic Approach , 9th edition. Oxford, UK: Elsevier; 2020.)

  • ◾

    Nodular disease : (a) single or multiple scleral nodules, of a deeper blue-red colour than episcleral nodules ( Fig. 9.2B ), (b) vascular congestion and dilatation with oedema and displacement of the entire beam of the slit lamp.

  • ◾

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

  • ◾

    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

Definition:

aggressive form of scleritis, bilateral in 60%, which may result in severe visual morbidity unless appropriately treated.

Diagnosis

Oct 30, 2022 | Posted by in OPHTHALMOLOGY | Comments Off on Episclera and Sclera

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