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- collagen fibres become thicker contrasts to thinning sclera
- fibres disrupted-> Ca deposits-> hyaline plaques
scleral hyaline plaques?
oval, dark grey area close to insertion of horiz rectus
- hereditary metabolic problem-> accum of homogenestic acid
- brown black discolouration at insertions of hoz rect
- rusty brown
- hered, accum excess dietary iron
blue-grey paralimbal discolouration
long term rust spots
diffuse: yellow discolouration?
- ocular melanocytosis
- naevus of ota
due to thinning and transparency- underlying uvea is visible
What is episcleritis?
- benign localised imflammation of episcleral tissue
- 70% idiopathic
- max congestion of episcleral vessels
- sudden onset eye red, hot, uncomfortable, prickling, NO PAIN
- sx: redness, upper temporal/nasal
- sectorial vs diffuse
- peak 12 hrs, resolves 10-21 days
- 1 week, 2-3w resolve
- recurs 1-3month
- mod-sev inflammation
- redness upon waking
- translucent nodule- granulomatous
- more painful than simple, self limiting
- assoc systemic
- primary inflammation of sclera
- vision threatening
- inflam of deeper tissues
- max congestion of deep vascular plexus
diffuse anterior scleritis?
- present: redness, aching later, pain f 50>
- sx: vascular cong, edema, grey blue, sclearl translucency, reccurent, benign
nodular anterior scleritis?
- present: slow pain, red, tender globe, history of HZO
- sx: single/multiple nodules, deep blue/red colour, scleral translucent after edema
- nodule not moveable
- ddx: episcleral nodular
necrotising scleritis with inflammation?
- pres: bi, old, gra pain,
- sx: nodular scleritis, vasc cong, scleral thining due to necrosis, blue choroid visible
- necrotising scleritis
- pres: irritaion, painless
- sx: yellow scleral plaques near limbus, slow prog scleral thinning, no inflammation
- elderly women RA
- pres: diffuse vs nodular, reduced vision, NO PAIN
- sx: retinal detachment, choroidal folds, disc edema
- ddx: subretinal mass-granuloma, choroidal folds- tumour infall disease, papilloedema, detach- seous retinopathy, orbital cellulitis
- RA- non nec- mild joint disease, nec- RA
- connective tissue disorders