4. Negative History
No history of trauma
No history of redness, pain, swelling
No history of joint pain
No history of any systemic illness
5. Ocular examination(26/09/2015 )
Right Eye Left Eye
VA ( UA ) 6/18 p N18 6/9
VA ( PH ) 6/6 p 6/6
Best Corrected Visual
Acuity
6/6 N 18 6/6 N 6
Lids Normal Normal
Conjunctiva Normal Normal
Sclera Normal Normal
Cornea Clear Clear
AC Deep , Quiet Deep , Quiet
6. Iris Normal colour ,pattern Normal colour , pattern
Pupil 2 mm reacting to light 2 mm reacting to light
Lens Clear Clear
Lacrimal apparatus Reguritation on pressure
negative
Reguritation on pressure
negative
Intraocular pressure 14 mm of Hg 14 mm of Hg
Fundus Described in diagram Media –clear
C D R 0.4 : 1
Neuroretinal rim healthy
Foveal reflex present
11. Ocular Oncology ( 29/09/2015 )
OD retinal elevation inferotemporal to the disc
Advise
B Scan to rule out choroidal/ retrobulbar mass
Retina opinion
39. Advise (15/12/2015 )
Impression of resolved posterior scleritis was made
To taper tablet Predinisolone over 5 weeks
Tablet Ranitine 150 mg 2 times a day * 5 weeks
To follow up after 6 weeks
40. Classification of Scleritis ( Watson & Hayreh )
Anterior
Diffuse
Nodular
Necrotizing with inflammation
Necrotizing without inflammation( scleromalacia
perforans )
Posterior
Jay H. Krachmer, MD, Mark J. Mannis, MD, FACS and Edward J. Holland, MD
41. Introduction
Posterior scleritis is defined as inflammation of the
scleral behind ora serrata
McClusky P , Watson P et al Posterior scleritis: Clinical features systemic
associations, and outcome in a large series of patients Ophthalmology
1999;106:2380–2386
42. McClusky P , Watson P et al Posterior scleritis: Clinical features systemic associations, and
outcome in a large series of patients Ophthalmology 1999;106:2380–2386
43. Symptoms
Acute loss of vision
Pain
Redness
Asthenopia
Benson W. Posterior Scleritis. Surv Ophthalmology 1988 S 32 :297 -316
44. Signs
Nodule on anterior sclera if associated with anterior
scleritis
Fundus signs
Fundal mass
Choroidal folds or retinal striae
Exudative retinal detachment
Cystoid macular edema
Benson W. Posterior Scleritis. Surv Ophthalmology 1988 S 32 :297 -316
45. B Scan
Thickening of posterior eye wall
Edema in retrobulbar space
T sign – fluid in subtenons space
Serous retinal detachment
Subretinal mass
Optic nerve head swelling
Biswas J, Mittal S, Ganesh SK, Shetty NS, Gopal. L. Posterior scleritis: Clinical profile and
imaging characteristics. Indian J Ophthalmol 1998;46:195-202
46. Fundus Fluorescein Angiography
Initial mottling of choroidal background
Followed by multiple pinpoint areas of
hyperfluorescein
Benson W. Posterior Scleritis. Surv Ophthalmology 1988 S 32 :297 -316
47. Fundus Fluorescein Angiography
In middle and late phases of angiogram these foci leak
fluorescein into subretinal space
Benson W. Posterior Scleritis. Surv Ophthalmology 1988 S 32 :297 -316
48. Differential diagnosis of Fundus mass
Benson W. Posterior Scleritis. Surv Ophthalmology 1988 32 :297 -316
49. Laboratory test for associated systemic disease
By Jay H. Krachmer, MD, Mark J. Mannis, MD, FACS and Edward J. Holland, MD
50. First line therapy
Beardsley RM, Suhler EB, Rosenbaum JT, Lin P. Pharmacotherapy of Scleritis:
Current Paradigms and Future Directions. Expert opinion on pharmacotherapy.
2013;14(4):411-424.
51. Immunosupressive drugs
Beardsley RM, Suhler EB, Rosenbaum JT, Lin P. Pharmacotherapy of Scleritis:
Current Paradigms and Future Directions. Expert opinion on pharmacotherapy.
2013;14(4):411-424
52. Biological response modifier
Beardsley RM, Suhler EB, Rosenbaum JT, Lin P. Pharmacotherapy of Scleritis:
Current Paradigms and Future Directions. Expert opinion on pharmacotherapy.
2013;14(4):411-424