Episcleritis

With From www.medicoapps.org

 Episcleritis
Episcleritis →Benign, self limited inflammation of episclera.

Diffuse Episcleritis: Nodular Episcleritis:

• Diffuse in distribution • Sectorial inflammation & diffuse
• Sectorial inflammation • Nodule present

→ Cause : Idiopathic
→Treatment: Reassurance; Topical NSAID’S.

With From www.medicoapps.org

 Scleritis

With From www.medicoapps.org

 Scleritis
Scleritis →Painful inflammation of sclera often associated with systemic disorders

Anterior Scleritis Posterior Scleritis

Inflammation anterior to rectus muscles Inflammation posterior to rectus muscles

With From www.medicoapps.org

Anterior Scleritis

With From www.medicoapps.org

 Anterior Scleritis
1.More common Anterior Scleritis

2.Diffuse

3.Nodular

4.Nectrotising with inflammation

5.Necorotising without inflammation

With From www.medicoapps.org

 Risk Factors
1. Oral NSAID’S
2. Systemic steroids
3. Immuno modulatory drugs [methotrexatel/ cyclosporine/ cyclophosphamide

With From www.medicoapps.org

 Treatment
1. Systemic autoimmune disease
2. Most common association is Rheumatoid arthritis**
3. More in women in their 50’s & 60’s
4. Pain: Severe boring ( characteristic)**; Exacerbated by movements; Worst at night
5. Redness & globe tenderness
6. Characteristic violet blue colour with scleral edema & dilated vessels.
7. Phenylephrine drops cannot blanch vessels.

With From www.medicoapps.org

Necrotizing Scleritis

With From www.medicoapps.org

 Necrotizing Scleritis
→ More severe & destructive form.
Necrotizing Scleritis
→ May lead to loss of eye due to perforation.

→Intense pain out of proportion.

→ White avascular areas surrounded by inflamed sclera

→ Rx by systemic immunotherapy & scleral grafting.

With From www.medicoapps.org

Scleromalacia Perforans

With From www.medicoapps.org

 Scleromalacia Perforans
→Necrotizing scleritis without inflammation (minimal signs & inflammation)
Necrotizing Scleritis
→Associated with long standing Rheumatoid Arthritis

→Sclera thins dark Uveal tissue visible

→ Staphyloma develops if IOP elevated.

→ Eyes rupture with minimal trauma.

With From www.medicoapps.org

Posterior Scleritis

With From www.medicoapps.org

 Posterior Scleritis
1.Difficult to diagnose
2.Pain, tenderness,

3.Proptosis

4.Visual loss & restricted motility

5.Choroidal folds, exudative retinal detachment, papilledema, Angle closure glaucoma

→ B scan ultrasonography – T sign**

→ Rx by systemic steroids, Cyclophosphomide.

With From www.medicoapps.org

 Episcleritis Vs Scleritis

Episcleritis Scleritis
No pain Painful
Bright red in colour Violet blue in colour
No scleral edema Scleral edema present
Not a/w systemic disorders Associated with systemic disorders
By 10% Phenylephrine drops By 10% Phenylephrine drops
Vessels undergo blanching Vessels do not blanch

With From www.medicoapps.org