Disease 16 - Sclera

  1. sceral discolouration?
    • ageing
    • collagen fibres become thicker contrasts to thinning sclera
    • fibres disrupted-> Ca deposits-> hyaline plaques
  2. scleral hyaline plaques?
    oval, dark grey area close to insertion of horiz rectus
  3. alcaptonuria?
    • hereditary metabolic problem-> accum of homogenestic acid 
    • brown black discolouration at insertions of hoz rect
  4. Haemochromatosis?
    • rusty brown
    • hered, accum excess dietary iron
  5. systemic minocycline?
    blue-grey paralimbal discolouration
  6. metallic fb?
    long term rust spots
  7. diffuse: yellow discolouration?
  8. diffuse: grey/black?
    • ocular melanocytosis
    • naevus of ota
  9. diffuse: blue?
    due to thinning and transparency- underlying uvea is visible
  10. What is episcleritis?
    • benign localised imflammation of episcleral tissue
    • 70% idiopathic
    • max congestion of episcleral vessels
  11. episcleritis sx?
    • sudden onset eye red, hot, uncomfortable, prickling, NO PAIN
    • sx: redness, upper temporal/nasal
    • sectorial vs diffuse
    • peak 12 hrs, resolves 10-21 days
  12. simple episcleritis?
    • diffuse/sectorial
    • common
    • 1 week, 2-3w resolve
    • recurs 1-3month
    • mod-sev inflammation
  13. Nodular episcleritis?
    • redness upon waking
    • translucent nodule- granulomatous
    • more painful than simple, self limiting
    • assoc systemic
  14. tx episcleritis?
  15. scleritis?
    • primary inflammation of sclera
    • vision threatening
    • inflam of deeper tissues
    • max congestion of deep vascular plexus
  16. diffuse anterior scleritis?
    • present: redness, aching later, pain f 50>
    • sx: vascular cong, edema, grey blue, sclearl translucency, reccurent, benign
  17. nodular anterior scleritis?
    • present: slow pain, red, tender globe, history of HZO
    • sx: single/multiple nodules, deep blue/red colour, scleral translucent after edema
    • nodule not moveable
    • ddx: episcleral nodular
  18. necrotising scleritis with inflammation?
    • pres: bi, old, gra pain,
    • sx: nodular scleritis, vasc cong, scleral thining due to necrosis, blue choroid visible
  19. scleromalacis perforans?
    • necrotising scleritis
    • pres: irritaion, painless
    • sx: yellow scleral plaques near limbus, slow prog scleral thinning, no inflammation
    • elderly women RA
  20. Posterior scleritis?
    • pres: diffuse vs nodular, reduced vision, NO PAIN
    • sx: retinal detachment, choroidal folds, disc edema
    • ddx: subretinal mass-granuloma, choroidal folds- tumour infall disease, papilloedema, detach- seous retinopathy, orbital cellulitis
  21. assoc systemic?
    • 50%
    • RA- non nec- mild joint disease, nec- RA
    • connective tissue disorders
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Disease 16 - Sclera