episcleritis
Introduction
Introduction to episcleritis Epithelial epithelial (episcleritis) is located in front of the equator, especially in the area between the limbus and rectus attachment. The course of disease is short, easy to relapse, and the prognosis is also good. About 2/3 of the patients are monocular, which is common in adults, and is often of two types in clinical practice. Nodular scleral epidermitis: Nodubalepirscleritis is a scleral epithelium characterized by localized nodules, the most common. Simple superficial scleritis: simple epithelial scleritis (simpleepisclertis) is mostly sudden eye swelling and eye pain. The hyperemia and edema of superficial scleritis is confined to the surface of the sclera, not to the sclera under it, and can be clearly identified by the beam of the slit lamp. The congestion is mostly dark red, and the blood vessels rapidly turn white after the adrenaline, and the deeper sclera Inflammation is purplish red, and it is not easy to fade after dropping adrenaline. basic knowledge Sickness ratio: 0.0001% Susceptible people: good for adult men and women Mode of infection: non-infectious Complications: cataract Glaucoma
Cause
Cause of episcleritis
Exogenous infection (30%):
It is less common for external factors, and can be directly caused by bacteria, viruses, fungi, etc. through conjunctival infections, trauma, surgical wounds, etc. The fungus (Fungus) is a eukaryote. The most common fungi are all kinds of mites, and fungi also include mold and yeast.
Endogenous infection (30%):
1. Suppurative metastasis (pyrogenic bacteria): Suppurative bacteria are bacteria that infect humans and cause suppurative inflammation. It is pathogenic to the human body and often causes suppurative infection of the skin, subcutaneous soft tissue, deep tissues and even abscesses of internal organs, and can also cause sepsis.
2. Non-suppurative granulomatous (tuberculosis, syphilis, leprosy).
Prevention
Surface scleritis prevention
1. Diet and nourishment: This method is very important for the prevention of this disease. It should be avoided to eat spicy, spicy and nourishing products. It is more suitable for eating hot food, otherwise it will help the heat. Should be more food, such as light fruit, to clear the eyes. Eat more clean and moist products, make the stool smooth, help to lead the evil. In addition, you should quit smoking and avoid alcohol, so as not to help the fire.
2, spiritual nursed back to health: the liver is open to the eyes, the anger is the liver. Therefore, it is advisable to avoid anger and liver injury, so as not to cause the liver fire to reverse the disease.
3, early treatment: for patients with rheumatoid arthritis, tuberculosis, leprosy, syphilis and other parts of the infection, need to be treated as soon as possible to prevent the spread to the sclera to form the disease.
Complication
Surface scleritis complications Complications cataract glaucoma
Can be complicated by cataract, uveitis, glaucoma and sclera thinning (defect).
Symptom
Superficial sclera symptoms Common symptoms Eyes, eyes, eyes, eyes, congestion, tears
1. Nodular scleritis: nodubal epirscleritis is a scleral epidermitis characterized by localized nodules, the most common cause, the cause is still unknown, and generally associated with rheumatoid arthritis or Collagen diseases such as nodular erythema are complicated, the course of disease is slow, and there is often a tendency to relapse.
Mostly acute, with redness, pain, shame, pain, tears and other symptoms, in the near limbus, especially in the temporal side, there is pink or purple, due to the extreme expansion of the deep vascular surface of the iris, red is As a result of vasodilation of the superficial bulbar conjunctiva, the nodule can be round or elliptical, and the bulbar conjunctiva on the surface of the nodule can be pushed freely, gout nodules, bright red, tuberculous nodules, and the top is yellow, and viral. When infected, the nodules are often not obvious. In the suppurative metastatic scleral epitheliitis, the nodules contain pus, which can be fluctuating; when it touches the nodules, it often causes pain, which is caused by stimulation of the ciliary ganglia. As a result, the conjunctival surface of the nodule is congested and edematous, and the color of the conjunctiva outside the nodule area is generally normal. The disease course is self-limited for about two weeks. The sarcoidosis is grayish white, gradually flattened, and then completely absorbed, leaving a surface limit. Into, grayish black, adhesion to the conjunctiva, and can continue in other places, multiple recurrences, can be extended to several months, even years, and both eyes are affected at the same time, because the general intraocular tissue is not invaded, and Ignore Effects, involving deep portion is formed deep scleritis. Histologically, the nodules are characterized by granulation tissue in all fibrin-like necrotic areas, surrounded by fibroblasts and multinucleated giant cells that are fenced.
2, simple superficial scleritis: simple episcleral scleritis (simple episclertis) mostly sudden eye swelling and eye pain, lesions of the scleral surface and bulbar conjunctiva diffuse hyperemia and edema, periodic recurrence, short duration , a few hours or days to heal; recurrence is not limited to one eye or the same site, but often in the front of the sclera, no localized nodules, occasionally may have eye pain, fear of light, and because of the iris sphincter and ciliary muscle It causes dilated pupils and temporary myopia. Neurological edema is seen in the eyelids during episodes, and severe cases may be accompanied by periodic migraine.
Examine
Examination of superficial scleritis
The hyperemia and edema of superficial scleritis is confined to the surface of the sclera, not to the sclera under it, and can be clearly identified by the beam of the slit lamp. The congestion is mostly dark red, and the blood vessels rapidly turn white after the adrenaline, and the deeper sclera Inflammation is purplish red, and it is not easy to fade after dropping adrenaline.
Laboratory inspection:
Blood routine, erythrocyte sedimentation rate, liver function, serum uric acid determination, syphilis serological test, tuberculin intradermal test, etc., immunological indicators: rheumatoid factor, peripheral blood T lymphocyte subsets, peripheral blood immunoglobulin, immune complex determination , anti-nuclear antibodies, complement C3 and so on.
Diagnosis
Diagnosis and differentiation of superficial scleritis
Differential diagnosis
Episcleritis should be differentiated from conjunctivitis and scleritis:
(1) The blood vessels of the conjunctiva can be promoted. In conjunctivitis, the congestion is diffuse and often accompanied by secretions; while the superficial scleral vessels are relatively immobile, and the superficial scleritis is confined in the area from the limbus to the rectus attachment point. The conjunctiva is not involved, and the congested blood vessels are radially vertical and extend from the limbus.
(2) Congestion and edema of superficial scleritis is confined to the surface of the sclera, not to the sclera under it, and can be clearly identified by the beam of the slit lamp. The congestion is mostly dark red, and the blood vessels quickly turn white after the adrenaline drops. Deep scleritis is hyperemia, and it is not easy to fade after adrenaline.
