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Chapter-08 Diseases of the Sclera

BOOK TITLE: Postgraduate Ophthalmology (2 Volumes)

Author
1. Vengayil Sujith
2. Vanathi M
3. Sangwan Virender S
4. Agrawal Rupesh V
ISBN
9789350252703
DOI
10.5005/jp/books/11051_31
Edition
1/e
Publishing Year
2012
Pages
12
Author Affiliations
1. Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Centre, AIIMS, New Delhi, Clinical Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar New Delhi, India, Clinical Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar New Delhi 110 029, India, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-110029, India
2. Clinical Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, AIIMS, New Delhi, India, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
3. LV Prasad Eye Institute, Hyderabad, India, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Banjara Hills, India, Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, LV Prasad Eye Institute, Hyderabad, LV Prasad Eye Institute; LV Prasad Eye Institute, Banjara Hills, Hyderabad 500034, Andhra Pradesh, India, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India, LV Prasad Eye Institute; LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India, L V Prasad Eye Institute; LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
4. LV Prasad Eye Institute, Kallam Anjil Reddy Campus, Banjara Hills, Hyderabad, India
Chapter keywords
episclera, thin densely vascularized layer, sclera, scleral disease, scleritis, vasculature, ocular and systemic associations, nodular anterior scleritis, multiple erythematous, tender inflamed nodules, anterior sclera, necrotizing scleritis, conjunctivitis, episcleral vessels, episcleritis, autoimmune diseases, rheumatoid arthritis (RA), patients, infectious scleritis, viral, parasitic, surgically induced necrotizing scleritis (SINS), ocular surgery, uric acid, rosacea, herpes and rheumatoid factor, gout, diffuse and nodular scleritis, systemic NSAID therapy, therapeutic failure, biopsy, intensive antibiotic therapy, infective scleritis

Abstract

The episclera is the thin densely vascularized layer of connective tissue overlying the sclera and situated beneath the Tenons capsule. Clinical aspects in scleral disease are explained. Scleritis and episcleritis have very distinct characteristics as in onset, pain, vasculature, ocular and systemic associations, response to treatment and complications. Nodular anterior scleritis is characterized by single or multiple erythematous, immovable, tender inflamed nodules on the anterior sclera and approximately 20 per cent of the cases may progress to necrotizing scleritis. In conjunctivitis, episcleral vessels are rarely inflamed. In episcleritis, there is a pricking dry sensation, with localized discomfort and slight ache but no severe pain. Most scleral diseases are associated with autoimmune diseases. Rheumatoid arthritis (RA) is the underlying disease in approximately one sixth of patients suffering from scleritis. Infectious scleritis may be bacterial, viral, fungal, protozoan or parasitic. Surgically induced necrotizing scleritis (SINS) is a rare complication of ocular surgery. With exclusion of conditions such as raised uric acid levels, gout, rosacea, atopy, herpes and rheumatoid factor, simple episcleritis generally does not require treatment as it is self-limiting and fades within a few days. For diffuse and nodular scleritis systemic NSAID therapy with sustained-release indomethacin 75 mg bid is prescribed. In case of therapeutic failure, high doses of systemic steroids is given and tapered slowly every week. Biopsy helps to identify the causative organism. Intensive antibiotic therapy, topical and systemic is usually required in cases of infective scleritis.

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