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Scleritis and Episcleritis DR. UMA KULKARNI PROFESSOR, OPHTHALMOLOGY JOINT SECRETARY, YU ETHICS COMMITTEE YENEPOYA UNIVE...

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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