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63 Cards in this Set

  • Front
  • Back
Name the 2 types of episcleritis
simple episcleritis
nodular episcleritis
What is the most common type of episcleritis?
simple episcleritis (80%)
What conditions is episcleritis associated with?
collagen vascular dz (autoimmune): RA, SLE, Chron's, gout

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

see T sign
blue sclera is seen in what condition
osteogenesis imperfecta
ehler's danlos
pseudoxanthoma elasticum
turner's
why does blue sclera occur?
defect in development of sclera
why does the sclera become blue in pts with blue sclera?
thinning leading to uvea showing through
what is Saturn's ring?
white ring around limbus seen in blue sclera represents contrast to adjacent thinning
ectasia
thining and bulging of sclera
most common sclera staphyloma due to high myopia and posterior uveitis
posterior staphyloma
staphyloma due to anterior inflammation (par planitis)
anterior staphyloma
staphyloma due to inflammation around limbus
intercalating staphyloma
total bulging of the eyes seen in congenital glaucoma (total staphyloma)
buphthalmos
scleral hyaline plaques
dark gray oval areas located at the insertion of horizontal rectus m.
yellow sclera (icteric) is due to
jaudice