Scleral Disease

China Medical University NO.4 Affiliated hospital Ophthalmology;

Ophthalmology hospital of China Medical University

Introduction

character

• Outer wall of eye. • Collagen fiber & elastic fiber• Lack of cell and vessels• Less capacity of self repairing—staphyloma

Scleral Disease ： Commonly found in inflammation （ disease course deferment ， medication inevident

）Scleral Disease Classifications ： Episcleritis Scleritis

Episcleritis

Nodular episcleritis ： acute in onset

symptoms:unilateral 、 wine 、 round or ellipse limited nodular uplift ， diameter 2 ～ 3mm

redness 、 edema irritation Vission not affected concurruent mild iritis the inflammation subsided in 2 to

4 weeks ， easily recurrent 。

Episcleritis

Simple episcleritis ： periodicity redness and edema light irritation,Vission not affect

ed concurruent lid edema ， dise

ase course deferment often found in Women's menstr

ual period self-limited

Episcleritis

Episcleritis Conjunctivitis scleritis

Congestion Localized Diffused, palpebral conjunctiva affected

Congestion and edema

Not affect sclera Affect sclera

Nodules movable unmovable

Adrenaline Disappear Disappear Not disappear

different diagnoses

Treatment：• Self-limiting• Corticosteroids:

– Eyedrop– ic

• NSAIDs: po

Episcleritis

Scleritis

• Inflammation of sclera• Severe than episcleritis• Young and mid-age adults• Female>Male• Autoimmune disease• Complicated with general c

ollagenous, granulomatous or metabolic diseases.

pathogeny ： Allergic reaction 。 Auto immune connective tissue diseases Metabolic diseases Other ： infection spreaded ， inflammation spreads in th

e vicinity of the organization 。

Scleritis

anterior Scleritis:disease site ： anterior equator ， bilateral eye

s current successively 。clinical manifestations ： pain, Vision decrease 、 sclera focus

course ： long 、 recurrent 、 defermentprognosis ： not goodcomplications ： Uveitis 、 Keratitis 、 Secondary

glaucoma e.g 。

Scleritis

Classification diffuse anterior scleritis

nodular anterior scleritis

necrotizing anterior scleritis

Scleritis

diffuse anterior scleritis

about 40 ％ prognosis preferably sclera diffuse redness bulbar conjunctiva ed

ema

diffuse anterior scleritis

nodular anterior scleritis

about 44 ％ Scleral lesions dark red inflammation Infiltrated nodular Uplift ， hard ，

pain concurruent Episcleritis

nodular anterior scleritis

necrotizing anterior scleritis

often Vision decrease ， about 14 ％

pain ， Rapid development occlusive vasculitis ， sclera nec

rosis areas of avascularity; lark nodula perforated scleromalacia perfora

ns often bilateral eyes concurruent Serious Autoimmun

e diseases

necrotizing anterior scleritis

Posterior Scleritis: disease site ： Posterior equator ， about 2 ％。 clinical manifestations ： pain ， eyelid and bulbar co

njunctiva edema ， eyeball slightly Prominent ， extraocular involved 。 Concurruent Uveitis 、Vitreous opacities e.g 。

diagnoses ： Examinations ， such as B-US 、 CT 、MRI,can show Posterior sclera thickening 。

different diagnoses ： Orbital cellulitis ， the symptoms and exophthalmus are even Obvious 。

Scleritis

treatment• Pathogeny treatment• Symptomatic treatment ： coldly cover 、 Artificial tears

。• Anti-inflammatory treatment ： corticosteroids 、 Immun

osuppressant e.g 。• Surgical treatment ： necrosic 、 perforative Scleral site

can be done with Allogeneic scleral graft 。• Complications treatment ： glaucoma 、 Iridocyclitis.

Scleritis

Sclera staphyloma

• definition ： Because of thinning of the sclera ， scler

a and deep uveal bulge and expand outward with the function of intraocular pressure,and revealed blue-black color of uveal color 。

• Classification ： anterior sclera staphyloma equatorial sclera staphyloma posterior sclera staphyloma

• treatment ： 1. Decompression early 2. If the eyes have been suffe

ring from no light perception ， And pain ，

eyes can be removed 。

Abnormal scleral color

• Scleral pigment plaques ： brown or blue-gray spots currented at anterior sclera surface and entrance of Ciliary vessels 。 Scleral melanosis syndrome 。

• Blue sclera ： It is caused by Uveal color under sclera because of thin sclera 。 concurruent congenital anomalies

• Sclera yellow Stained ： Jaundice

• Brown macular:Brown-gray spots at sclera ， which current at Palpebral fissure area earliest 。

It can be distributed in the sclera, cornea and conjunctiva 。 No clinical significance 。