Sclera

Aka: Sclera, Scleral Icterus, Yellow Sclera, Episclera, Lamina Cribrosa

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II. Physiology

  1. Sclera
    1. Thick, protective outer coat of the eye underlying the Conjunctiva
    2. Poorly vascularized
    3. Normally white (with possible bluish discoloration) and opaque
    4. Scleral inflammation is very painful, and associated with Vision Loss
  2. Episclera
    1. Covers the anterior Sclera and lacks the Scleral bluish discoloration
    2. Continuous with the Cornea
    3. Episcleral inflammation is not typically painful, and does not cause Vision change
  3. Lamina Cribrosa of Sclera
    1. Sleeve-like space at the opening of the Sclera through which Retinal axons pass on their way to the Optic Nerve
    2. Represents hundreds of openings through which 1-2 Million nerves pass (bundled into groups)
    3. Retinal axons are particularly sensitive to injury at the lamina cribosa, where the axons bend and exit the eye
      1. Lamina Cribrosa is an important landmark for Glaucoma related-injury to Retinal axons

III. Findings: Normal

  1. Normally white and opaque

IV. Causes: Scleral Inflammation

  1. Scleritis
  2. Episcleritis

V. Causes: Scleral Discoloration

  1. Blue Sclera suggests Osteogenesis Imperfecta
  2. Yellow Sclera Causes
    1. Carotenemia does not involve the Sclera
    2. Scleral Icterus
      1. Hyperbilirubinemia (associated with Jaundice)
      2. Bilirubin uniformly deposits throughout Sclera
    3. Quinacrine
      1. Yellow discoloration near limbus
    4. Yellow subscleral fat (normal)
      1. Involves only the area farthest from the limbus

VI. Reference

  1. Degowin (1987) Bedside Diagnostic Exam, p. 480

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Related Studies

Ontology: Scleral Diseases (C0036412)

Definition (NCI_CTCAE) A disorder characterized by involvement of the sclera of the eye.
Definition (NCI) A disorder affecting the sclera. Examples include inflammatory processes (e.g., scleritis and episcleritis), and degenerative processes. Primary tumors of the sclera are extremely rare.
Definition (MSH) General disorders of the sclera or white of the eye. They may include anatomic, embryologic, degenerative, or pigmentation defects.
Concepts Disease or Syndrome (T047)
MSH D015422
ICD10 H15.9 , H15
SnomedCT 33064008
English Disease, Scleral, Diseases, Sclera, Diseases, Scleral, Sclera Disease, Sclera Diseases, Scleral Disease, Scleral Diseases, Disease, Sclera, Disorder of sclera, unspecified, SCLERA DIS, SCLERAL DIS, disorder of sclera, disorder of sclera (diagnosis), Scleral disorder NOS, Sclera Disorder, Scleral Disorder, Disorders of sclera, Unspecified disorder of sclera, Scleral Diseases [Disease/Finding], sclera disease, sclera diseases, sclera disorders, disease sclera, diseases sclera, scleral diseases, disorders scleral, Scleral disorder, Disorder of sclera (disorder), Disorder of sclera, disease (or disorder); sclera, Disorder of sclera, NOS
Italian Patologia della sclera, Patologia della sclera NAS, Malattie della sclera
Dutch sclera-aandoening NAO, aandoening; sclera, Aandoening van sclera, niet gespecificeerd, sclera-aandoening, Aandoeningen van sclera, Scleraziekte, Scleraziekten, Ziekte, sclera-, Ziekten, sclera-
French Trouble de la sclère SAI, Trouble de la sclère, Maladies de la sclérotique
German Erkrankung der Sklera NNB, Affektion der Sklera, nicht naeher bezeichnet, Affektionen der Sklera, Erkrankung der Sklera, Lederhauterkrankungen (Auge), Sklerakrankheiten
Portuguese Alteração da esclerótica NE, Alteração da esclerótica, Doenças da Esclera
Spanish Trastorno de la esclerótica NEOM, Enfermedades de la Esclerótica, Enfermedades de la Esclera, trastorno de la esclerótica (trastorno), trastorno de la esclerótica, Trastorno de la esclerótica
Japanese 強膜障害, 強膜障害ＮＯＳ, ｷｮｳﾏｸｼｮｳｶﾞｲNOS, ｷｮｳﾏｸｼｮｳｶﾞｲ, 強膜疾患, 鞏膜疾患
Swedish Sklerala sjukdomar
Finnish Kovakalvon sairaudet
Russian SKLERY BOLEZNI, СКЛЕРЫ БОЛЕЗНИ
Czech Porucha skléry NOS, Sklerální porucha, nemoci bělimy, skléra - nemoci, nemoci skléry
Korean 공막의 장애, 상세불명의 공막의 장애
Polish Choroby twardówki
Hungarian Scleralis betegség k.m.n., Sclerabetegség
Norwegian Sclerasykdommer, Sklerale sykdommer, Sykdommer i sclera, Sykdommer i sklera, Sklerasykdommer
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Structure of lamina episcleralis (C0229109)

Definition (NCI) A thin fibrous membrane that covers the outer surface of the anteriors sclera and contains blood vessels which supply the sclera.
Concepts Body Part, Organ, or Organ Component (T023)
SnomedCT 10695007, 302022001
English Episclera, Epislcera, Episcleral layer of eyeball, Episcleral layer, Episclera (body structure), Lamina episcleralis, Structure of lamina episcleralis (body structure), Structure of lamina episcleralis, Epislcera (body structure), Episcleral Layer
Spanish episclerótica, epiesclerótica, epiesclerótica (estructura corporal), episclerótica (estructura corporal), estructura de la lámina epiesclerótica (estructura corporal), estructura de la lámina epiesclerótica, lámina epiesclerótica
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Lamina cribrosa of sclera (C0229114)

Concepts Body Part, Organ, or Organ Component (T023)
SnomedCT 30322002
English Lamina cribrosa sclerae, Structure of lamina cribrosa of sclera (body structure), Structure of lamina cribrosa of sclera, Lamina cribrosa of sclera
Spanish estructura de la lámina cribosa de la esclerótica (estructura corporal), estructura de la lámina cribosa de la esclerótica, lámina cribosa de la esclerótica
Derived from the NIH UMLS (Unified Medical Language System)

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