Term
| Loose vascularized connective tissue between conj and sclera |
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Definition
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Term
|
Definition
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Term
| Which type of episcleritis is more common? |
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Definition
| 80% of cases is simple episcleritis |
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Term
| What is the cause of most cases of simple episcleritis |
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Definition
| Most (70%) are idiopathic |
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Term
| What are some causes of simple episcleritis aside from idiopathic cases |
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Definition
Collagen vascular dz
Gout
HZV
Syphillis
Trauma/foreign body
Sarcoidosis
TB |
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Term
| objective presentation of Simple Episcleritis |
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Definition
diffuse or sectoral hyperemia
engorged BV
lacrimation
deep injection
possible AC reaction |
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Term
| Name 5 differential diagnosis for episcleritis cases |
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Definition
Conjunctivitis
Pinguecula
Keratoconjunctivitis
Anterior uveitis
Scleritis |
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Term
| How may phenylephrine 2.5% be used to diagnose episcleritis? |
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Definition
When drops of phenylephrine are instilled in a case of episcleritis, the conj vessels will blanch.
They will not blanch if it is a case of scleritis instead |
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Term
| 3 important features in diagnosing episcleritis |
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Definition
Case history
Clinical exam (in natural light and under slit lamp)
Phenylephrine 2.5%
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Term
| Treatment of mild cases of episcleritis |
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Definition
| Generally just supportive treatment like lubricants and cold compresses |
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Term
| 3 drug classes that may be used to bring relief to a more serious case of episcleritis |
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Definition
Topical vasoconstrictors or antihistamine (get red out)
Mild topical steroid
Topical NSAIDs |
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Term
| Treatment for Moderate-severe cases of episcleritis |
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Definition
Supportive tx
Topical steroid qid
Oral NSAID |
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Term
| 2 Oral NSAIDs given for moderate-severe episcleritis cases |
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Definition
Ibuprofen qid
Naproxen bid |
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Term
| Specify which mild topical steroid is best to use for episcleritis and why. |
|
Definition
Use lotemax
It is better than Pred Forte because it does not raise IOP and a bit more mild. |
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Term
| How often should you recheck the episcleritis patient to whom you have given steroids? |
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Definition
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Term
| When do you refer your episcleritis patient for systemic workup? |
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Definition
|
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Term
| Which form of episcleritis presents with more pain, simple or nodular? |
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Definition
| Nodular has more intense pain |
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|
Term
| How is vision generally affected by episcleritis |
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Definition
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Term
| How do you determine if the elevated, red, nodule that is in the center of the inflammation is due to scleral or episcleral inflammation? |
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Definition
If the nodule is mobile over the sclera, it is episcleral.
If it is fixed it is scleral |
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Term
| Treatment of nodular episcleritis |
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Definition
Same as moderate-severe simple form
Topical steroid q2h-qid
Oral NSAID |
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Term
| Follow-up for nodular episcleritis |
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Definition
Weekly if given steroid
RTC every 2-3 weeks otherwise |
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|
Term
| What proportion of scleritis is due to underlying systeminc dz? |
|
Definition
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|
Term
| Common presentation when scleritis has a systemic cause? |
|
Definition
|
|
Term
| 5 Classifications of Scleritis |
|
Definition
Diffuse Anterior
Nodular Anterior
Necrotizing anterior w/ inflammation
Necrotizing anterior w/o inflammation
Posterior |
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|
Term
| Which is the most common and least severe form of scleritis |
|
Definition
| Diffuse Anterior Scleritis |
|
|
Term
| 3 disorders associated with anterior diffuse scleritis |
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Definition
Rheumatoid Arthritis
HZV
Gout |
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|
Term
| Which class of scleritis is thought to cause the most extreme eye pain anyone can experience? |
|
Definition
| Necrotizing anterior scleritis with inflammation |
|
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Term
| What other disorders may be indicated by necrotizing anterior scleritis with inflammation |
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Definition
| Potentially lethal underlying systemic vasculitis |
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|
Term
| What happens to the sclera in necrotizing anterior scleritis with inflammation? |
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Definition
|
|
Term
| What is scleromalacia perforans? |
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Definition
| Necrotizing anterior scleritis without inflammation |
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|
Term
| Disorder commonly associated with anterior necrotizing scleritis without inflammation |
|
Definition
| Long-standing Rheumatoid Arthritis |
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|
Term
| How is necrotizing anterior scleritis without inflammation different than the kind with inflammation? |
|
Definition
| No inflammation-almost no sxs even though it has the same destructive course |
|
|
Term
| 50% of patients with this ocular presentation die from systemic vascular events |
|
Definition
| Patients with necrotizing scleritis |
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Term
| Posterior Scleritis may simulate what other ocular condition |
|
Definition
| Amelanotic choroidal mass |
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|
Term
| Name some signs/ocular complications associated with Posterior scleritis |
|
Definition
Exudative Retinal Detachment
Disc Swelling
Retinal hemorrhage
Choroidal folds
Restricted EOMs
Proptosis
Pain
Tenderness |
|
|
Term
| Correlation between posterior scleritis and systemic disease |
|
Definition
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|
Term
| How is vision generally affected by scleritis? |
|
Definition
| 'Insidious' decrease in VA |
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|
Term
T/F
Discharge is associated with scleritis |
|
Definition
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|
Term
T/F
Scleritis has an acute, sudden onset |
|
Definition
| False, gradual onset over many days |
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|
Term
| PT complains of pain that wakes them up at night and is only temporarily helped when they take Aleve, what condition do you need to consider? |
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Definition
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|
Term
| What scleral changes may occur over the course of a scleritis episode? |
|
Definition
-may have a bluish hue
-may be thin or edematous
-scleral nodules may form |
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Term
| What corneal changes may occur with scleritis? |
|
Definition
Peripheral thinning
Deep stromal/endothelial disruption |
|
|
Term
| Name the 2 most common connective tissue diseases that can cause scleritis |
|
Definition
Rheumatoid Arthritis
Wegener's granulomatosis |
|
|
Term
| Name 5 Connective tissue disorders that are associated with scleritis |
|
Definition
RA
Wegener's granulomatosis
Ankylosing spondylitis
Systemic Lupus Erythematosus
Polyarteritis Nodosa |
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|
Term
Name 6 Vasculitic diseases associated with Scleritis
|
|
Definition
Polyarteritis Nodosa
Wegener's Granulomatosis
Allergic angiitis of Churg-Strauss syndrome
Cogan syndrome
Giant cell arteritis
Behcet dz |
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|
Term
T/F
Foreign body can cause scleritis |
|
Definition
|
|
Term
| Name 5 pieces of case history that must be asked about when considering scleritis as a diagnosis |
|
Definition
Connective tissue/vasculitic disease
Infectious disease
Blunt/penetrating ocular trauma
Past ocular surgical procedures, esp within 1 yr
Drugs
|
|
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Term
| How may topical anesthetic be used in diagnosing a scleritis/episcleritis |
|
Definition
Apply anesthetic and apply pressure with a cotton swab
If no pain=conjunctivitis or uveitis
If pain=episcleritis or scleritis |
|
|
Term
| What type of ultrasound may be useful in diagnosing posterior scleritis |
|
Definition
|
|
Term
| Which type of angiography is best for visualizing the site of maximum inflammation and is used when assessing treatment success |
|
Definition
| Indocyanine Green Angiography |
|
|
Term
T/F
Scleritis can result in glaucoma |
|
Definition
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Term
| Tx of non-infectious scleritis other than treating underlying cause |
|
Definition
Topical Steroid + cycloplege
Oral NSAID (for non necrotizing) |
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|
Term
| Name 4 Oral NSAIDs used to treat non-necrotizing scleritis |
|
Definition
Flurbiprofen (100 mg tid)
Ibuprofen 600-800mg po qid
Indomethacin 25-75mg po bid x 1 week
Naproxen 375-500mg po tid |
|
|
Term
| Treatment of noninfective non-necrotizing scleritis when oral NSAIDs are contraindicated |
|
Definition
| Prednisone 60-100mg PO qd x 3-5 days then taper |
|
|
Term
| First line of treatment of necrotizing scleritis |
|
Definition
Cyclophosphamide
Cyclosporine
Methotrexate |
|
|
Term
| Resolution timeline in episcleritis vs. scleritisq |
|
Definition
Epi=1-3 weeks
Scleritis=possibly years |
|
|
Term
| What advantage does FA angiography have over ICG? |
|
Definition
| FA identifies new corneal vessels and leakage, ICG does not. |
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