SCLERITIS

SCLERITIS

DEF-

Edema & cellular infiltration of entire scleral thickness.

CAUSES-
1.Systemic-
* RA
* Wegener’s granulomatosis
* Relapsing polychondritis
* PAN

2.Surgery-
* Cataract surg
* RD surg
* Filtration surg
* pterygium excision + beta radiation + MMC

3.Infections-
* Corneal ulcer
*Trauma
* Org- Pseudo aeruginosa, strep pneumo, staph aureus, varicella zoster

CLASS-

1. Anterior scleritis-

1. Non-necrotizing-Diffuse or nodular
2. Necrotizing- With or without inflamn

2.Posterior scleritis

ANTERIOR NON-NECROTIZING SCLERITIS-

1 ]Diffuse scleritis-

*   Inv a sector or entire anterior sclera

*   Distorts the nml radial vascular pattern

2] Nodular scleritis-

*   Scleral nodule cannot be moved over the underlying tiss

*   Dark red or bluish, later purple

T/T-

1.Oral NSAIDs

2.Oral steroids

3. Steroids + NSAIDs

4.S/C Triamcinolone acetonide 40mg/ml

ANTERIOR NECROTIZING SCLERITIS-

WITH INFLAMMATION-

• Localized redness
• Pain-radiates to temple,brow or jaw
• Congestion of deep vascular plexus.
• Vascular distortion & occlusion → avascular patches
• Scleral necrosis with overlying conj ulceration
• Resolution → scleral thinning→uvea visible as bluish tinge
• COMPLICATIONS-Staphyloma

                                    -Cataract

                                    -Keratitis

                                    -Keratolysis

                                    -Sec glaucoma

                                    -Macular edema

T/T-

1.Oral steroids

2.Immunosuppressives-

Cyclophosphamide-1-2 mg/kg/day

Azathioprine-1-3mg/kg/day

Cyclosporin-2-5 mg/kg/day

3.Combined therapy-

Pulsed IV methylprednisone 1gm + cyclophosphamide 500mg

WITHOUT INFLAMN -

Also k/as –SCLEROMALACIA PERFORANS

• Asymptomatic yellow ,necrotic,scleral patches in uninflamed sclera
• Scleral thinning→  exposes uvea
• Staphyloma
• T/T- ineffective

POSTERIOR SCLERITIS-

C/F-

• Pain
• Visual impairment
• Lid edema
• Proptosis
• O’plegia
• Asstd ant scleritis
• Fundus-Disc edema, mac edema,choroidal folds,exud RD,Ring choroidal det& subretinal lipid exud
  

INV-

2. USG-“ T” sign-Thickening in post sclera & fld in tenon’s space.
   Stem of T is formed by optic N & cross-bar by fluid in subtenon’s space
   
   
3. CT SCAN- Posterior scleral thickening

T/T- same