Scleritis1
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This document discusses scleritis, an inflammation of the sclera. It defines scleritis and notes it is less common than episcleritis. Scleritis can be classified as anterior or posterior, with anterior scleritis subdivided into non-necrotizing diffuse/nodular or necrotizing forms with or without inflammation. Associated systemic diseases are common in 45% of patients. Signs, symptoms, investigations, and treatment are described depending on the classification of scleritis. Surgical treatment may be needed for extreme scleral thinning or corneal complications.
Scleritis1
- 2. SCLERITIS Dr.Fuad A K Niazi, Assistant Professor, Rawalpindi medical college, Department of Ophthalmology, Holy Family Hospital.
- 3. Scleritis
- 4. OBJECTIVES • Definition • Incidence • Classification • Signs & Symptoms. • Specific investigations. • Treatment
- 5. DEFINITION Scleritis is a granulomatous inflammation of the sclera.
- 6. Scleritis
- 7. Episcleritis
- 8. Incidence It is much less common than episcleritis. Women are commonly affected in the 5th and 6th decade. Usually bilateral.
- 9. Pathology • There is dense infiltration of the scleral tissue by lymphocytes.
- 10. Classification 1.Anterior scleritis(95%) a.Non-necrotizing:diffuse or nodular b.Necrotizing: with or without inflammation 2.Posterior scleritis(5%)
- 11. Associated Systemic Diseases • 45% of patients may have the following associated diseases: 1.Rheumatoid arthritis 2.Connective issue disorders 3. Miscellaneous: relapsing polychondritis,herpes zoster,gout,surgically induced scleritis etc
- 13. Anterior non- necrotizing scleritis 1.Presentation: Severe discomfort,tenderness and watering of eyes. 2.Signs: a)Diffuse scleritis-Widespread inflammation Distortion of vascular pattern Benign progression b)Nodular Scleritis-Nodular appearance Intermediate severity
- 16. Anterior necrotizing scleritis with inflammation 1.Presentation: Most severe form with gradual onset of pain and localized redness . 2. Signs: a) Distortion or occlusion of blood vessels b) Development of scleral necrosis c) Gradual spread of necrosis around the globe d) Presence of associated anterior uveitis indicative of very severe disease involving ciliary body Complications: corneal involvement,cataract,glaucoma.
- 17. Anterior necrotizing scleritis with inflammation
- 18. Anterior necrotizing scleritis without inflammation 1. Presentation: Asymptomatic 2. Signs: Starts with a yellow necrotic patch Large areas of uvea become exposed 3. Complications: Perforation rare unless IOP elevated
- 19. Anterior necrotizing scleritis without inflammation(scleromalacia perforans)
- 20. Posterior scleritis • Presentation: Variable,pain and visual impairment • Signs: Eyelid oedema Proptosis Opthalmoplegia Associated anterior scleritis present in 40% of cases • Ophthalmoscopy: Disc swelling Macular oedema Retinal detachment Vitritis Ring Choroidal detachment Choroidal folds Subretinal mass Intraretinal white deposits
- 22. Posterior scleritis(cont…) • D/D: Optic neuritis Rhegmatogenous RD Choroidal tumour Orbital inflammatory disease or mass Uveal effusion syndrome Harada disease • USG: Thickening of posterior sclera with fluid in tenon space • CT: Thickening of posterior sclera with fluid in tenon space
- 23. Choroidal folds over macula
- 24. B-scan
- 25. Treatment • ANTERIOR NON-NECROTIZING SCLERITIS: Oral NSAIDS(flurbiprofen 100mg x tds) Oral prednisolone(40-80mg x od) Combination therapy of NSAIDS and lower dose steroids. • ANTERIOR NECROTIZING SCLERITIS WITH INFLAMMATION: Oral prednisolone(60-120mg x od tapered accordingly) Immunosuppressive agents Combined therapy with pulsed i.v methylprednsolone(500-1000mg) and cyclophosphamide(500mg)
- 26. Treatment(cont…) • ANTERIOR NECROTIZING SCLERITIS WITHOUT INFLAMMATION: No effective treatment • POSTERIOR SCLERITIS: a)Elderly patients with associated systemic disease are treated in the same way as those with anterior necrotizing scleritis. b)Young patients without associated systemic disease usually respond well to NSAIDS.
- 27. Surgical treatment • Extreme scleral thinning requires reinforcement. • Corneal marginal ulceration or keratolysis may require corneal grafting .