Ant Seg Test 2 - Episclera And Sclera

Front 1

inner layer of sclera

Back 1

lamina fusca; blends with suprachoroidal and supraciliary lamellae of the uveal tract

Front 2

anterior episclera

Back 2

dense, vascular; between superficial scleral stroma and Tenon capsule

Front 3

most superficial vascular layer covering ant. sclera

Back 3

conjunctival vessels -> arteries tortuous, veins straight

Front 4

middle vascular layer covering ant. sclera

Back 4

vessels within Tenon capsule

-"superficial episclera"
-vessels straight with radial config.
-can be manually moved over sclera
-most congested layer in episcleritis
-topical phenylephrine will blanch (whiten) conjunctiva and Tenon vessels

Front 5

deepest vascular layer covering ant. sclera

Back 5

deep vascular plexus

-covers superior part of sclera
-"deep episclera"
-most congested layer in scleritis
-phenylephrine will not blanch (whiten) this layer

Front 6

scleral stroma is largely {vascular/avascular}

Back 6

avascular

Front 7

episcleritis, general info

Back 7

-common, benign, self-limiting, frequently recurrent
-typically affects young adults
-may be associated with systemic disease
-NEVER progresses to a scleritis
-may be simple (most common) or nodular

Front 8

episcleritis S/S

Back 8

unilateral redness; mild discomfort, tenderness, watering

simple -> sectoral redness (diffuse less common)

nodular -> sectored redness; localized, raised, congested nodule involving Tenon capsule (ant. sclera not raised)

Front 9

diffuse redness in episcleritis often confused for ______________, DDx is...

Back 9

conjunctivitis; palpebral surface won't be red in episcleritis (no palpebral sclera) but will be in conjunctivitis

Front 10

_______ episcleritis typically recurrent, results in...

Back 10

nodular; superficial scleral lamellae become more parallel, making sclera appear translucent (this is not scleral thinning)

Front 11

_______ episcleritis resolves spontaneously within _________; _______ episcleritis takes longer to resolve

Back 11

simple; 1-2 weeks; nodular

Front 12

episcleritis Tx

Back 12

mild cases -> simple lubricants or vasoconstrictors

more symptomatic or recurrent cases -> topical steroids

prolonged inflammation or severe recurrent cases -> oral NSAIDS

Front 13

scleritis, general info

Back 13

-red and VERY painful
-edema and cellular infiltration of entire thickness of the sclera
-MUCH less common than episcleritis
-varies from trivial self-limiting to necrotizing

Front 14

scleritis etiologies

Back 14

-systemic associations
-surgically induced
-infectious

Front 15

scleritis, systemic associations

Back 15

-50% of patients
-rheumatoid arthritis most common by far

Front 16

scleritis, surgically induced

Back 16

-etiology unknown
-typically within 6mo post-op
-more common in females
-focal area of intense inflammation and necrosis adjacent to Sx site

Front 17

scleritis, infectious

Back 17

-most commonly from corneal ulcer infection
-may be associated with trauma
-may follow excision of pterygium
-most common organisms: Pseudomonas, Strep., Staph., Varicella Zoster

Front 18

scleritis, anatomical classification

Back 18

-anterior scleritis (98%)
   > non-necrotizing (85%): diffuse or nodular
   > necrotizing (13%): w/ or w/out inflam.
-posterior scleritis (2%) - post. eye, difficult to Dx

Front 19

diffuse ant. non-necrotizing scleritis signs

Back 19

inflammation (sectoral or entire ant. sclera), distortion of normal radial pattern, benign (doesn't progress to nodular)

Front 20

nodular ant. non-necrotizing scleritis signs

Back 20

may resemble nodular episcleritis, scleral nodule can't be moved, intermediate severity (visual impairment ~25%)

Front 21

ant. non-necrotizing scleritis Tx

Back 21

-oral NSAIDs
-oral prednisone in patients resistant to or intolerant of NSAIDs
-combined therapy -> NSAID + lower dose of steroid, used when either alone ineffective
-subconjunctival steroid injection -> systemic therapy used only for non-necrotizing disease

Front 22

ant. necrotizing scleritis with inflammation

Back 22

-most severe form of scleritis
-bilateral 60% but often not simultaneous
-usually associated systemic vascular disease
-mortality rate of 25% within 5 yrs
-visual prognosis poor

Front 23

ant. necrotizing scleritis with inflammation symptoms

Back 23

-pain -> radiates to temple, brow, or jaw and responds poorly to analgesia
-localized redness

Front 24

ant. necrotizing scleritis with inflammation signs (in chronological order)

Back 24

-congestion of deep vascular plexus
-vascular distortion and occlusion with resultant avascular patches
-scleral necrosis which gradually spreads
-scleral thinning upon resolution -> bluish tinge due to uveal visibility

Front 25

ant. necrotizing scleritis with inflammation complications

Back 25

-Staphyloma (bulge/protrusion of uveal tissue) formation and occasional perforation, esp. if IOP elevated
-ant. uveitis -> extension of inflam.; may develop 2° cataract, glaucoma, and macular edema; high incidence of visual impairment

Front 26

ant. necrotizing scleritis with inflammation Tx

Back 26

-oral prednisolone -> reduces severity of pain
-immunosuppressive agents -> necessary in steroid resistant cases
-combine therapy -> intravenous steroids and immunosuppressive agent; reserved for patients who fail to resolve with oral therapy or have established scleral necrosis

Front 27

ant. necrotizing scleritis without inflammation

Back 27

-a.k.a. scleromalacia perforans
-more common in women with long-standing rheumatoid arthritis
-typically bilateral
-Tx ineffective

Front 28

scleromalacia perforans

Back 28

ant. necrotizing scleritis without inflammation

Front 29

ant. necrotizing scleritis without inflammation signs (in chronological order)

Back 29

-asymptomatic yellow necrotic scleral patches in uninflamed sclera
-enlargement, spread and coalescence
-progressive exposure of underlying uvea (scleral thinning)
-Staphyloma formation (bulge/protrusion of uveal tissue)

Front 30

staphyloma

Back 30

bulge due to protrusion of sclera or cornea, usually lined with uveal tissue

Front 31

post. scleritis

Back 31

-uncommon and often mis-Dx
-affects women twice as much as men
-patients over 50 at increased risk
-2/3 cases unilateral
-no correlation with systemic disease
-1/3 cases - permanent visual impairment
-presentation variable, depends on affected area

Front 32

post. scleritis S/S

Back 32

-pain and visual impairment most common symptoms
-blepharedema, proptosis, ophthalmoplegia, associated ant. scleritis 1/3 of cases
-disc swelling, macular edema, choroidal folds, exudative retinal detachment, ring choroidal detachments, subretinal lipid exudation

Front 33

post. scleritis testing

Back 33

-ultrasonography -> thickening of post. sclera and fluid in Tenon space; "T" sign
-CT scan -> post. scleral thickening

Front 34

post. scleritis DDx

Back 34

-optic neuritis
-rhegmatogenous retinal detachment
-choroidal tumor
-orbital inflammatory disease or mass
-uveal effusion syndrome
-Harada disease
-intraocular lymphoma

Front 35

post. scleritis Tx

Back 35

-older adults -> oral predisolone, immunosuppressive agents, combined therapy
-young patients -> respond to NSAIDs

Front 36

scleral discoloration, focal

Back 36

-senile scleral translucency
-alkaptonuria
-haemochromatosis
-systemic minocycline/tetracycline
-metallic F.B. -> rust staining

Front 37

senile scleral translucency

Back 37

-normal with old age
-oval, dark-grayish areas
-white halo surrounding area

Front 38

alkaptonuria

Back 38

-brown-black discoloration at the insertions of horizontal recti and pigmentation of the pinnae (auricle, outer ear)

Front 39

haemochromatosis

Back 39

-excess iron deposited over time
-rusty-brown discoloration

Front 40

systemic minocycline

Back 40

-causes blue-gray paralimbal discoloration in interpalpebral area
-photosensitizing properties

Front 41

scleral discoloration, diffuse

Back 41

-yellow -> jaundice
-blue -> scleral thinning

Front 42

causes of scleral thinning

Back 42

-ant. necrotizing scleritis with and without inflammation
-Osteogenesis imperfecta
-Ehlers-Danlos syndrome
-Pseudoxanthoma elasticum
-Turner syndrome

Front 43

scleral discoloration, miscellaneous

Back 43

-Phtisis Bulbi -> shrunken eye and calcified sclera due to chronic, long-term, untreatable disease or improperly treated trauma
-Melanosis Oculi -> flat, dark pigment on sclera in dark-skinned people; not a concern
-Axenfeld's Loop -> normal situation in which nerve comes up then loops back, causing a small dark spot; often superior sclera