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Optic Neuropathies Associated with Systemic Disorders And Radiation-Induced Optic Neuropathy
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Ocular involvement is seen in approximately 50–60% of GPA patients and 8% of affected individuals experience disease-related vision loss (10). Any part of eye may be affected, albeit the condition most often manifests as orbital disease, followed by scleral, episcleral, corneal and nasolacrimal abnormalities (10). Early recognition of the ocular features can be pivotal to identifying active disease, and preventing vision loss. Optic nerve involvement may develop from contiguous inflammation in the setting of orbital inflammation, or local compression (1). When orbital disease occurs, it can extend from its origin in the maxillary or ethmoid sinuses, and spread to involve the extraocular muscles, nerves or blood vessels (1, 10). Alternatively, inflammation can arise in the orbit, and spread throughout the retrobulbar space (1, 10). Patients may present with proptosis, ocular motility deficits and pain (1). In some cases, affected individuals develop exposure keratopathy and corneal ulceration, which in turn, leads to permanent vision loss.
Comparative Anatomy and Physiology of the Mammalian Eye
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
Toxic injury to the cornea can result from caustic agents, solvents, surfactants, and detergents. In general, these agents may produce a sensation of itching or burning, pain, conjunctival and episcleral hyperemia, corneal ulceration, deposits in the corneal epithelium and/or stroma, endothelial damage, and possibly inflammation of the anterior portion of the eye, termed anterior uveitis. These are discussed in detail in Chapter 15.
Special Senses
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Kenneth A. Schafer, Oliver C. Turner, Richard A. Altschuler
The sclera is an outer supportive tunic of the globe composed of collagenous connective tissue and covered anteriorly by the episclera (Hockwin et al. 1991; Samuelson 2007). The episclera is a vascularized layer between the bulbar conjunctiva that contains lymphoplasmacytic cell infiltrates in a response to superficial corneal irritation. Alterations of the sclera are often secondary to primary findings in other ocular structures or may occur spontaneously, such as osseous or cartilaginous metaplasia of aging rats. The sclera may also contain iatrogenic injection tracks, incisions, or sutures (Short 2008; Yoshitomi and Boorman 1990).
Clinical Profile of Scleritis Presenting for the First Time in the Elderly
Published in Ocular Immunology and Inflammation, 2023
Kowsigan Magesan, Janani Surya, Sudharshan Sridharan, Vineeta Nair, Mamta Agarwal, Amala Elizabeth Agarwal, Jyotirmay Biswas, Parthopratim Dutta Majumder
The index study is a hospital-based retrospective analysis of all patients ≥60 years who developed scleritis for the first time and managed at a tertiary eye center between January 2008 and December 2018. The study was approved by the institutional review board of the hospital and adhered to the tenets of the declaration of Helsinki. Scleritis was diagnosed by clinical examination based on characteristic ophthalmic symptoms and signs like excruciating pain with congestion of the deeper episcleral vessels, scleral edema, and congestion, scleral nodule, evidence of scleral necrosis, with scleral thinning or defect. Posterior scleritis was diagnosed by fundus examination and confirmed with B-scan ultrasonography. Scleritis was further categorized into anterior diffuse, nodular, necrotizing, and posterior scleritis. Patients who developed scleritis before 60 years of age were excluded from the analysis. Patients with insufficient documentation or follow-up of less than 6 months were excluded from the study. The index study excluded patients with microbiologically proven infective scleritis (with the specimens obtained by scleral scraping), prior history of intraocular inflammation, surgically induced necrotizing scleritis, history of immunosuppression, chemotherapy and neoplasm. The study also excluded the patients with viral scleritis and cases of scleral inflammation that required or were treated with local or topical antimicrobial agents empirically or presumptively.
Role of anterior segment optical coherence tomography in scleral diseases: A review
Published in Seminars in Ophthalmology, 2023
Raghav Preetam Peraka, Somasheila I Murthy
i. Diffuse episcleritis: In simple episcleritis, the findings include normal conjunctival epithelial reflectance with a mild increase in episcleral thickness and increased thickness of the episcleral vascular network with multiple oval optically clear structures representative of the cut section of dilated episcleral vessels (Figure 1d). No apparent change in scleral stromal reflectance or thickness can be made out and there is no change in the scleral contour. Clear demarcation between episcleral and sclera is also noted. The total thickness might be moderately increased as compared to the normal sclera.2ii. Nodular episcleritis: In nodular episcleritis, the changes on AS-OCT can be rather dramatic. A large, localized area of hypo-reflectivity within the episclera along with adjacent hypo reflective spaces which corresponds to episcleral nodule with dilated episcleral vessels can be noted. In the case of large nodules, the underlying posterior limit of the sclera cannot be made out. Where visible, scleral thickness and reflectance remain unaltered, however, the surface of the sclera may show a convex configuration. Posterior shadowing can be noted below the nodule, which can obscure the scleral findings. Resolution of episcleritis either spontaneously or on treatment restores the pattern of episclera with normalization of thickness and reflectivity pattern.
Cataract Surgery in the Setting of Scleritis
Published in Ocular Immunology and Inflammation, 2021
Amit Palkar, Sridharan Sudharshan, Amala Elizabeth George, Sudha K Ganesh, Jyotirmay Biswas, Parthopratim Dutta Majumder
Scleritis is a vision-threatening, painful inflammation of the sclera which may eventually involve the cornea, adjacent episclera, and underlying uvea. One-third to half of the patients with scleritis are associated with some underlying systemic disorders.1–5 Cataract formation has been reported with an incidence of 17% in eyes with scleritis in a cohort followed up for 11 years.6 Cataract formation in patients with scleritis can be secondary to both scleral inflammation and corticosteroid therapy. Despite our expanding knowledge of scleritis, there is a paucity of literature on cataract and its surgical management in scleritis. Various studies on scleritis have discussed cataract as a subset of complications. The current study was undertaken to understand the pattern of cataract and its outcome in patients with scleritis who underwent cataract surgery.