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63 Cards in this Set
- Front
- Back
Name the 2 types of episcleritis
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simple episcleritis
nodular episcleritis |
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What is the most common type of episcleritis?
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simple episcleritis (80%)
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What conditions is episcleritis associated with?
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collagen vascular dz (autoimmune): RA, SLE, Chron's, gout
TB, lyme dz, herpes zoster, syphilis |
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Is episcleritis unilateral or bilatera;?
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both - 66% unilateral
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Who typically gets episcleritis?
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females between 2nd-4th decade
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Does episcleritis recur?
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Yes. Suspect underlying disease if it recurs
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What is the tx of episcleritis?
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most cases spontaneously resolve without tx
can Rx topical steroid, oral NSAID, cool compresses, and cool AT |
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presentation of episcleritis
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acute onset of redness and nonspecific irritation such as warmth, prickling sensation, and localized eye pain (doesn't radiate)
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signs of episcleritis
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diffuse or sectoral redness of episcleral and conjunctival vessels - may be mild to brick red color
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what are signs that are absent in episcleritis?
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AC rxn
discharge bluish tinge |
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How long does simple episcleritis typically last?
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10-21 days
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clinical presentation of nodular episcleritis
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less acute onset, redness, nonspecific irritation and pain, development of nodule within the area of redness
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what surrounds the nodule in nodular episcleritis?
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congestion of episclera and conjunctival vessels
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what does the nodule in nodular episcleriis represent?
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celllular infiltrate
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clinical signs of nodular episcleritis
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one or more nodules located within center of the wedge; surrounding congestion and edema; mobile nodule
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how long does nodular episcleritis last?
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2-3 months
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how can you differentiate episcleritis from scleritis
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use 10% phenylephrine - blanches episcleral and conjunctival vessels; does not blanch deep scleral vessels
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how can you differentiate nodular episcleritis from nodular scleritis?
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nodules in episcleritis move
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List the types of scleritis
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diffuse anterior scleritis
nodular anterior scleritis necrotizing anterior scleritis with infllammation necrotizing anterior scleritis without inflammation - scleromalacia perforans posterior scleritis |
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how is the pain in episcleritis different from the pain in scleritis?
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pain in diffuse anterior scleritis and nodular scleritis can radiate to face and temple
pain in necrotizing scleritis can radiate from face, jaw, temple, sinus -->extreme |
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describe the appearance of the injection seen in scleritis
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red-blue (violacious) hue
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what is the most common form of anterior scleritis?
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diffuse anterior scleritis
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clinical presentation of diffuse anterior scleritis
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radiating pain with ocular redness
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signs of diffuse anterior scleritis
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congested and dilated vessels
generalized or localized to one quadrant edema |
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what is the VA prognosis of anterior diffuse scleritis?
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good
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what happens to the sclera in anterior scleritis?
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it becomes transparent and is thus seen as blue because you can see the underlying choroid
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clinical presentation of nodular scleritis
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insidious onset of pain with redness, tenderness of globe, and nodule
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clinical signs of nodular scleritis
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single or multiple IMMOBILE nodules with deep blue-red color
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do scleral nodules blanch with 10% phenylepehrine?
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no
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what can happen to the nodules in nodular scleritis?
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they can coalesce and expand
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clinical presentation of necrotizing anterior scleritis with inflammation
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gradual onset of pain which becomes extreme and radiates to temple, jaw, sinus, face...localized area of acute congestion of vessels which become occluded and distorted
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signs of necrotizing anterior scleritis with inflammation
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nodular scleritis with deep vascular congestion with scleral thinning due to necrosis whic may extend around the globe
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condition which begins with localized area of acute congestion which become distorted or occluded causing a painful and injected eye
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necrotizing anterior scleritis
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complication that occurs in 40% of patients with necrotizing anterior scleritis
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scleral thining which can extend around globe causing perforation
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complications that occur in 60% of patients wuth necrotizing anterior scleritis
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peripheral corneal ulceration
uveitis uveal effusion glaucoma hypotony perforation |
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what is the visual prognosis of necrotizing anterior scleritis?
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extremely poor - VA threatening
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95% of cases of necrotizing anterior scleritis without inflammation (scleromalacia perforans) are associated with which condition?
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rheumatoid arthritis
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what is the most destructive consequence of necrotizing anterior scleritis?
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progressive scleral thinning due to necrosis that leads to perforation
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what is the name of necrotizing anterior scleritis that occurs without inflammation?
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scleromalacia perforans
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TX of necrotizing anterior scleritis
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STAT referal in advanced stage
NSAIDS H2 blocker immunosupressives oral steroids |
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what is scleromalacia perforans characterized by?
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complete lack of symptoms - pt may present with non-specific irritation
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does the patient note pain or VA issues with scleromalacia perforans?
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no
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signs of scleromalacia perforans
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yellow scleral necrotic plaques at limbus without congestion or inflammation
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what happens in scleromalacia perforans?
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the necrotic plaques coalesce and enlrage leading to progressive scleral thinning
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posterior scleritis prognosis
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poor
it is a extremely destructive condition that is difficult to diagnose |
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presentation of posterior scleritis
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pain, discomfort, tenderness of globe to palpation
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why is posterior scleritis difficult to diagnosis
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because you can not see the inflammation because its located at the posterior sclera
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what are the effects of posterior scleritis?
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loss of vision
severe pain globe perforation loss of eye |
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signs of posterior scleritis
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proptosis
choroidal folds RD subretinal mass disc edema myosistis may see anterior sclera involvement |
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when should you suspect posterior scleritis?
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when high pain/discomfort outweighs clinical signs
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tool used to dx posterior scleritis
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B scan US
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what does the B scan US show in posterior scleritis
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fluid in Tenon's capsule
see T sign |
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blue sclera is seen in what condition
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osteogenesis imperfecta
ehler's danlos pseudoxanthoma elasticum turner's |
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why does blue sclera occur?
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defect in development of sclera
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why does the sclera become blue in pts with blue sclera?
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thinning leading to uvea showing through
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what is Saturn's ring?
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white ring around limbus seen in blue sclera represents contrast to adjacent thinning
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ectasia
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thining and bulging of sclera
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most common sclera staphyloma due to high myopia and posterior uveitis
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posterior staphyloma
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staphyloma due to anterior inflammation (par planitis)
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anterior staphyloma
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staphyloma due to inflammation around limbus
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intercalating staphyloma
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total bulging of the eyes seen in congenital glaucoma (total staphyloma)
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buphthalmos
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scleral hyaline plaques
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dark gray oval areas located at the insertion of horizontal rectus m.
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yellow sclera (icteric) is due to
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jaudice
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