SCLERAL DISORDERS
Episcleritis is a benign and frequently recurrent disorder in adolescents and young adults, presenting with raised congested nodules near the limbus, rarely associated with other signs of inflammation.
It is usually considered as a hypersensitivity reaction to variety of antigens, e.g. tuberculosis or syphilis, or associated with autoimmune rheumatic disorders. Recovery is spontaneous in 2-3 weeks, though topical steroids may be used in symptomatic cases.Scleritis is more acute and severe inflammation of sclera, rare in children. It is a rapidly progressive inflammation with severe pain and scleral thinning, occasionally seen in rheumatoid disorders, e.g. juvenile rheumatoid arthritis and SLE.
Scleral discoloration is an important guide for many systemic disorders, e.g. icterus (yellow), cyanosis (bluish- hue vascularity), alkaptonuria (black), etc.
Blue sclera indicates relatively thin sclera, due to: (a) developmental immaturity in normal newborns and infants), (b) collagen disorders, e.g. osteogenesis imperfecta, Ehler-Danlos syndrome, etc. and (c) excessive stretching, e.g. Buphthalmos and high myopia.
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