L3: Sclera

Question 1

Anatomy of The Sclera

Answer 1

Question 2

Anatomy of The Sclera

• site

Answer 2

• Strong fibrous layer
• It forms the posterior ⅚ of the external coat of the eye

Question 3

Anatomy of The Sclera

• Thickness

Answer 3

• About 1m
• It is thinnest at the attachment of extraocular muscles

Question 4

Anatomy of The Sclera

• Color

Answer 4

Question 5

Anatomy of The Sclera

• Blood Supply

Answer 5

Avascular, therefore infections rarely affect it

Question 6

Apertures & Structures passing through The Sclera

Answer 6

Question 7

Function of The Sclera

Answer 7

Question 8

Diseases of The Sclera

The surest sign of scleral rupture is ……..

Answer 8

prolapsed intraocular contents

Question 9

Def of Episcleritis

Answer 9

inflammation of the episcleral tissue

Question 10

Def of Scleritis

Answer 10

Inflammation affects all layers of the sclera

Question 11

Incidence of Episcleritis

Answer 11

• It is more common in females
• There is usually bilateral involvement

Question 12

Incidence of Scleritis

Answer 12

• It is more serious than episcleritis
• There is usually bilateral involvement

Question 13

Etiology of Episcleritis

Answer 13

Question 14

Etiology of Scleritis

Answer 14

1. 50% of cases are Idiopathic.
2. 50% of cases are associated with rheumatoid arthritis.

Question 15

Symptos of Episcleritis

Answer 15

• Discomfort and lacrimation.
• Tenderness on pressing the globe.

Question 16

Symptoms of Scleritis

Question 17

Signs of Episcleritis

Answer 17

Question 18

Signs of Episcleritis

• Nodular Type

Answer 18

• Lentil size, well circumscribed
• Purple due to dilatation of deep vessels
• Tender
• Conjunctiva moves freely over it

Question 19

Signs of Episcleritis

• Diffuse Type

Answer 19

• Dilated episcleral vessels
• Frequently affecting only one sector

Question 20

Signs of Scleritis

• Anterior Type

Answer 20

• Diffuse
• Annular
• Nodular: Nodule is deep & fixed to sclera
• Necrotizing: serious, may cause perforation
• Scleromalacia perforans: melting of quiet sclera

Question 21

Signs of Scleritis

• Posterior Type

Answer 21

• Severe pain and uveitis
• With Exudative retinal detachment

Question 22

DDx of Episcleritis

Answer 22

Episcleritis should be differentiated from phlycten

Question 23

Complications of Episcleritis

Answer 23

1. Severe neuralgia may occur due to nerve involvement.
2. Scleritis from deeper infiltration of inflammation.

Question 24

Complications of Scleritis

Answer 24

• Uveitis
• Sclerosing keratitis
• Scleral staphyloma

Question 25

TTT of **Episcleritis**

Answer 25

**Topical Steroids:** - Prednisolone & Dexamethasone **Oral NSAIDs:** - Diclofenac, Ketorolac

Question 26

TTT of **Scleritis**

Answer 26

(Topical steroids, usually ineffective) **Oral NSAIDs:** - Diclofenac, Ketorolac **Oral steroids:** - Prednisolone (1 - 2 mg/kg/day) **Immunosuppressives**

Question 27

Def of **Staphyloma**

Answer 27

Ectatic scar of the outer coat of the eye, lined by atrophic uveal tissue

Question 28

Classification of **Staphyloma**

Answer 28

Question 29

Classification of **Staphyloma** - Corneal

Answer 29

Question 30

Classification of **Staphyloma** - Scleral

Answer 30

Question 31

**Scleral Staphyloma** - Intercalary

Answer 31

- 2 - 3 mm zone with the limbus weakened by Schlemm's canal and lined by atrophic iris and peripheral anterior synechia

Question 32

**Scleral Staphyloma** - Ciliary

Answer 32

Bulged sclera lined by ciliary body

Question 33

**Scleral Staphyloma** - Equatorial

Answer 33

Bulged sclera lined by atrophic chorio-retinal tissue

Question 34

**Scleral Staphyloma** - Posterior

Answer 34

Question 35

**Posterior Scleral Staphyloma** - Def

Answer 35

Bulged sclera lined by choroid temporal to the optic disc

Question 36

**Posterior Scleral Staphyloma** - RF

Answer 36

- High myopia - Retrobulbar injection

Question 37

**Posterior Scleral Staphyloma** - Ex

Answer 37

- It is seen by ophthalmoscope - It is the only staphyloma with normal IOP

Question 38

**Posterior Scleral Staphyloma** - Characterestic Features

Answer 38

It is the only staphyloma with normal IOP