Scleritis and Episcleritis DR. UMA KULKARNI PROFESSOR, OPHTHALMOLOGY JOINT SECRETARY, YU ETHICS COMMITTEE YENEPOYA UNIVERSITY
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Objectives Understand the various aspects of Scleritis and
Episcleritis
Aetiology Clinical features Complications Diagnosis Management Differences
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
What is sclera? Anatomy
Extent of sclera
Sclera is the tough
outer covering of the eye Opaque Composed of collagen and elastin Relatively avascular Minimal inflammatory response
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
What is episclera? Anatomy
Extent of episclera
Episclera
The loose connective tissue superficial to the sclera Deep conjunctival tissue
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Comparison of episcleritis and scleritis
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Episcleritis and Scleritis: a comparison Episcleritis
Dr. Uma Kulkarni, Yenepoya University
Scleritis
05/07/2017
Episcleritis and Scleritis: Aetiology Episcleritis
Often associated with
connective tissue disorders most commonly rheumatoid arthritis
Dr. Uma Kulkarni, Yenepoya University
Scleritis
Very often associated
with connective tissue disorders most commonly rheumatoid arthritis
05/07/2017
Spectrum of connective tissue disorders
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Episcleritis and Scleritis: Symptoms Scleritis
Episcleritis
Red eye
Red eye
Acute
Acute/ chronic
Unilateral/ bilateral
Bilateral/ unilateral
Little or No pain
Pain
Discomfort in the eye
Mild discharge
No discharge
Bluish or brownish
discoloration Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Episcleritis and Scleritis: Clinical classification Episcleritis
Diffuse Nodular
Scleritis
Anterior Diffuse Nodular Necrotizing with inflammation Necrotizing without inflammation
Posterior
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Episcleritis
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
1. Diffuse episcleritis Clinical features
Appearance
Sectoral redness Usually temporally Engorgement of large
episcleral vessels Mild to moderate tenderness
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
2. Nodular episcleritis Clinical features
Appearance
A nodule
Circumscribed Dark red/purple Hard nodule Mild tenderness
Dense leucocytic
infiltration Little away from the limbus Conjunctiva freely mobile Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Episcleritis Complications Complications
1. Scleritis
Scleritis 2. Recurrent episcleritis: (Episcleritis periodica fugax) 3. Chronic episcleritis 4. Slate coloured scar 1.
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Episcleritis Management Diffuse and Nodular Episcleritis
Management
Mild cases :
1. 1. 2.
Lubricant eye drops NSAID eye drops
2. Moderate to severe
cases: 1.
Mild steroid eye drops
3. Unresponsive cases: 1. Oral NSAIDs Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Scleritis
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
1. Diffuse Scleritis Clinical features
Appearance
Hard whitish areas In the perilimbal area
with overlying congestion
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
2. Nodular Scleritis Clinical features
Appearance
Nodules One or more Very localized Dark red/ purplish Porcelain like in late stages Extensive nodules Around the limbus Annular Scleritis Dr. Uma Kulkarni, Yenepoya University
05/07/2017
3. Necrotizing Scleritis with inflammation Clinical features
Appearance
Severe painful red eye Commonly associated
with complications High risk of systemic disease and mortality
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
4. Necrotizing Scleritis without inflammation Scleromalacia perforans
Appearance
Features
Painless scleral
thinning and melting
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
5. Posterior scleritis Clinical features
CT scan of the orbit showing enhancement of the sclera (arrow)
Inflammation and
thickening of sclera Not associated with systemic disease Usually no pain/redness of eyes Mild proptosis Restriction of ocular movements
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Complications of Anterior Scleritis Scleral thinning
Dr. Uma Kulkarni, Yenepoya University
Staphyloma
05/07/2017
Complications of Anterior Scleritis Uveitis
Dr. Uma Kulkarni, Yenepoya University
Keratitis and thinning of the cornea
05/07/2017
Complications of Anterior Scleritis Sclerosing Keratitis
Keratolysis
(tongue shaped corneal opacity)
(Corneal melting)
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Complications of Posterior scleritis Fundus findings and complications
Fundus changes
Macular edema Optic disc edema Choroidal folds
Choroidal detachment Uveal effusion Exudative Retinal
detachment Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Management of scleritis Surgical
Medical
Oral NSAIDs Oral Prednisolone 1 mg/kg OD 1 week; Tapered over 2-3 weeks Immunosuppressive: Cyclophosphamide Methotrexate Cyclosporine
Scleral patch graft
Remember:
Biopsy is contraindicated Topical steroids ineffective Periocular injections can be dangerous (perforation)
Lubricants Dr. Uma Kulkarni, Yenepoya University
05/07/2017
So now we know The various aspects of Scleritis and Episcleritis Aetiology Clinical features Complications Diagnosis Management Differences
Dr. Uma Kulkarni, Yenepoya University
05/07/2017
Probable exam questions Theory
Practical/ viva
Causes of red eye
Causes for red eye
Differences between
Scleromalacia
episcleritis and scleritis
Dr. Uma Kulkarni, Yenepoya University
perforans Episcleritis as compared to scleritis
05/07/2017
Reading material For understanding
Dr. Uma Kulkarni, Yenepoya University
For images
05/07/2017
Dr. Uma Kulkarni, Yenepoya University
05/07/2017