1. Scleral Disease China Medical University NO.4 Affiliated hospital Ophthalmology; Ophthalmology hospital of China Medical University

2. Introduction character Outer wall of eye. Collagen fiber & elastic fiber Lack of cell and vessels Less capacity of self repairing—staphyloma Scleral Disease ： Commonly found in inflammation （ disease course deferment ， medication inevident ） Scleral Disease Classifications ： Episcleritis Scleritis

3. Episcleritis Nodular episcleritis ： acute in onset symptoms :unilateral 、 wine 、 round or ellipse limited nodular uplift ， diameter 2 ～ 3mm redness 、 edema irritation Vission not affected concurruent mild iritis the inflammation subsided in 2 to 4 weeks ， easily recurrent 。

4. Episcleritis Simple episcleritis ： periodicity redness and edema light irritation,Vission not affected concurruent lid edema ， disease course deferment often found in Women's menstrual period self-limited

5. Episcleritis Conjunctivitisscleritis CongestionLocalizedDiffused, palpebral conjunctiva affected Congestion and edema Not affect scleraAffect sclera Nodulesmovableunmovabl e AdrenalineDisappear Not disappear different diagnoses

6. Treatment ： Self-limiting Corticosteroids: –Eyedrop –ic NSAIDs: po Episcleritis

7. Scleritis Inflammation of sclera Severe than episcleritis Young and mid-age adults Female>Male Autoimmune disease Complicated with general collagenous, granulomatous or metabolic diseases.

8. pathogeny ： Allergic reaction 。 Auto immune connective tissue diseases Metabolic diseases Other ： infection spreaded ， inflammation spreads in the vicinity of the organization 。 Scleritis

9. anterior Scleritis: disease site ： anterior equator ， bilateral eyes current successively 。 clinical manifestations ： pain, Vision decrease 、 sclera focus course ： long 、 recurrent 、 deferment prognosis ： not good complications ： Uveitis 、 Keratitis 、 Secondary glaucoma e.g 。 Scleritis

10. Classification diffuse anterior scleritis nodular anterior scleritis necrotizing anterior scleritis Scleritis

11. diffuse anterior scleritis about 40 ％ prognosis preferably sclera diffuse redness bulbar conjunctiva edema

12. diffuse anterior scleritis

13. nodular anterior scleritis about 44 ％ Scleral lesions dark red inflammation Infiltrated nodular Uplift ， hard ， pain concurruent Episcleritis

14. nodular anterior scleritis

15. necrotizing anterior scleritis often Vision decrease ， about 14 ％ pain ， Rapid development occlusive vasculitis ， sclera necrosis areas of avascularity; lark nodula perforated scleromalacia perforans often bilateral eyes concurruent Serious Autoimmune diseases

16. necrotizing anterior scleritis

17. Posterior Scleritis: disease site ： Posterior equator ， about 2 ％。 clinical manifestations ： pain ， eyelid and bulbar conjunctiva edema ， eyeball slightly Prominent ， extraocular involved 。 Concurruent Uveitis 、 Vitreous opacities e.g 。 diagnoses ： Examinations ， such as B-US 、 CT 、 MRI,can show Posterior sclera thickening 。 different diagnoses ： Orbital cellulitis ， the symptoms and exophthalmus are even Obvious 。 Scleritis

18. treatment Pathogeny treatment Symptomatic treatment ： coldly cover 、 Artificial tears 。 Anti-inflammatory treatment ： corticosteroids 、 Immunosuppressant e.g 。 Surgical treatment ： necrosic 、 perforative Scleral site can be done with Allogeneic scleral graft 。 Complications treatment ： glaucoma 、 Iridocyclitis. Scleritis

19. Sclera staphyloma definition ： Because of thinning of the sclera ， sclera and deep uveal bulge and expand outward with the function of intraocular pressure,and revealed blue-black color of uveal color 。 Classification ： anterior sclera staphyloma equatorial sclera staphyloma posterior sclera staphyloma

20. treatment ： 1. Decompression early 2. If the eyes have been suffering from no light perception ， And pain ， eyes can be removed 。

22. Abnormal scleral color Scleral pigment plaques ： brown or blue- gray spots currented at anterior sclera surface and entrance of Ciliary vessels 。 Scleral melanosis syndrome 。 Blue sclera ： It is caused by Uveal color under sclera because of thin sclera 。 concurruent congenital anomalies Sclera yellow Stained ： Jaundice Brown macular: Brown-gray spots at sclera ， which current at Palpebral fissure area earliest 。 It can be distributed in the sclera, cornea and conjunctiva 。 No clinical significance 。