Scleritis and Episcleritis Dr Soujanya K MBBS MS
Scleritis and Episcleritis Dr. Soujanya K MBBS, MS, DNB, FPRS Asst. Professor, YMCH
sclera episclera Sclera proper Lamina fusca
Inflammation Superficial (Episcleritis) Deep (Scleritis)
Episcleritis • • • Benign Idiopathic Recurrent and B/L (Most commonly) young adults , F>M • Deep subconjunctival connective tissues, including the superficial scleral lamellae
Symptoms • Redness and mild discomfort • No DISCHARGE
• episcleral vessels- dilated • radial direction • beneath the conjunctiva mild-to-moderate tenderness
Simple Diffuse Sectoral Nodular
Nodular episcleritis • nodule • immovable • Conjunctiva freely mobile • Traversed by the deeper episcleral vessels so that it looks purple, not bright red.
Treatment Lubricants Mild topical Steroids Potent topical steroids Oral NSAIDs Severe
Scleritis • • Chronic inflammation of sclera F>M Elderly Underlying connective tissue disease + 50% – PAN, SLE, RA, Reiter syndrome, AS etc
Classification Scleritis Anterior Posterior
Nodular Anterior Diffuse Necrotising
Necrotising With inflammation Without inflammation
Classification Nodular Scleritis Anterior Diffuse Posterior Necrotising With inflammation Without inflammation
Symptoms • • moderate to severe pain localised or diffuse redness mild to severe photophobia lacrimation.
Diffuse 1 or more quadrant of anterior sclera. The area is raised and salmon pink to purple in colour
Nodular scleritis Purplish elevated scleral nodules, usually situated near the limbus
Necrotizing scleritis with inflammation • Intense inflammation • infarction • Necrosed sclera thinned out with uveal tissue shining through it. • Anterior uveitis +
Necrotizing scleritis without inflammation (scleromalacia perforans) • Elderly women with RA • Misnomer, perforationrare • Pain is absent and vision unaffected. • No vascular congestion
Posterior scleritis • Sclera behind the equator. • Inflammation of adjacent structures, – exudative retinal detachment, – macular oedema, – proptosis and – limitation of ocular movements.
Investigations • TO r/o underlying collagen vascular disease
Treatment Local steroids INEFFECTIVE X oral NSAIDs, oral prednisolone Intravenous methylprednisolone Imunosuppressive Reduced S/E
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