Episcleritis

Episcleritis
It is common benign, self-limiting, frequently recurrent disorder affecting young adult
Clinical features:
a/ simple: the redness may be sectoral ,rarely diffuse
b/ nodular: presented with discomfort , tenderness to touch and watering , it is localized in one area of the eye forming a nodule with surrounding redness
Treatment:- Topical steroids
? rarely systemic indomethacine 50mg/ twice daily

Scleritis
it is less common than episcleritis, it is affecting older age groups. Female > male, it is characterized by ocular pain with blinding complications. It is highly associated with systemic diseases
Causes:
1- H.Z.: is the commonest cause
2- Connective tissue disorders as Rheumatoid arthritis, S.L.E. ,poly arteritis nodosa
3- Miscellaneous causes: e.g. sarcoidosis , Behcet disease , ulcerative colitis , ankylosing spondylitis and T.B.
Treatment: - topical + systemic steroids
-systemic indomethacine (non steroidal anti inflammatory drug )
Clinical types: it is divided into
1/ anterior ; which is divided into –a/ necrotizing--- with inflammation
--- Without inflammation
-b/ non necrotizing- nodular
- diffuse
2/ posterior:
Non necrotizing (diffuse type): the inflammation is wide spread involving the whole posterior sclera
Treatment: -- topical and systemic steroids
-- Systemic indomethacine
Necrotizing scleritis (with inflammation)
It is the most severe form of scleritis
C.F.
Gradual onset of ocular pain with redness then the sclera becomes transparent and associated with anterior uveitis
Complications: including cataract, glaucoma, keratolysis leading to perforation of cornea
Treatment: systemic steroids 60—80 mg daily
Necrotizing scleritis without inflammation (sclero malacia perforance)
It is typically occur in female with long standing (sero +ve) rheumatoid arthritis, it is asymptomatic with yellow necrotic patch with scleral thinning
Treatment: systemic steroids
- cyto toxic drugs but no effective treatment