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   Table of Contents      
BRIEF REPORT
Year : 2004  |  Volume : 52  |  Issue : 1  |  Page : 59-60

Bilateral senile scleral plaques mimicking post-inflammatory scleral ectasia


Department of Ocular Immunology and Uveitis, L V Prasad Eye Institute, Hyderabad, India

Correspondence Address:
Somasheila I Murthy
Department of Ocular Immunology and Uveitis, L V Prasad Eye Institute, Hyderabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 15132382

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  Abstract 

Scleral plaque is a commonly occurring change in older individuals. We report a case of bilateral scleral plaques seen in an elderly female patient. This current case report describes a common but often missed benign scleral change in the elderly individual.

Keywords: Scleral plaque, senile hyaline plaque, scleromalacia perforans


How to cite this article:
Murthy SI, Sangwan VS. Bilateral senile scleral plaques mimicking post-inflammatory scleral ectasia. Indian J Ophthalmol 2004;52:59-60

How to cite this URL:
Murthy SI, Sangwan VS. Bilateral senile scleral plaques mimicking post-inflammatory scleral ectasia. Indian J Ophthalmol [serial online] 2004 [cited 2019 Dec 8];52:59-60. Available from: http://www.ijo.in/text.asp?2004/52/1/59/14629



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Senile scleral plaques are a commonly noticed but rarely diagnosed or often misdiagnosed scleral change.[1] These are areas of hyalinisation over the insertions of the horizontal rectus muscles and are seen in the elderly. These slate-gray scleral discolorations are sometimes confused with post-inflammatory scleral thinning or scleral tumour.[2] We report a case of bilateral senile scleral plaques, initially diagnosed as post-inflammatory scleral thinning and referred to us for further management.


  Case report Top


A 69-year-old woman presented in July 2000 with gradual, painless visual loss in both eyes over the past several months. She had been treated for hypertension and coronary artery disease for seven years and osteoarthritis for 20 years.

Her best-corrected visual acuity was 6/36 in the right eye and 6/15 in the left eye. External examination in both eyes demonstrated oval, slate-gray lesions measuring 3mm in diameter, located just anterior to the insertion of the lateral rectus in the right eye [Figure - 1]a and to the medial rectus in the left eye [Figure - 1]b and [Figure - 2]. The rest of the ocular examination, including fundus examination was unremarkable except for the presence of 3+ nuclear sclerosis in both eyes. The initial diagnosis was post inflammatory scleral thinning. Based on the colour, typical location and translucency of the lesions, a diagnosis of senile scleral plaques was made.

Since the findings were pathognomonic and the condition benign, no further investigations or treatment were recommended. Subsequently, the patient underwent uneventful cataract surgery and her postoperative visual acuity was 6/6 in both eyes. There was no change in the scleral plaques over a follow-up period of 20 months.


  Discussion Top


This case highlights the diagnostic confusion that can occur in cases of scleral plaque. These hyaline plaques occur typically as bilaterally symmetrical lesions in individuals over 50 years of age and appear as a dark, oval, non-progressive patch 2 to 3mm in diameter surrounded by a dense calcareous yellowish ring; the centre of the patch appears translucent, allowing a view of the underlying uvea.[1]

In the past, these benign senile lesions were suspected to be an extraocular extension of uveal melanomas,[3] conjunctival malignant melanoma,[4] necrotising scleritis,[5] scleromalcia perforans[6] and postinflammatory scleral thinning (present case). The findings of bilaterality, typical location (anterior to horizontal muscle insertion), and transillumination help distinguish this from other conditions.

The clinical features that help distinguish the various differential diagnoses are summarised in [Table - 1].

The aetiopathogenesis of scleral plaque is as follows: Over a period of time, accumulated actinic damage from solar irradiation[7] leads to gradual disruption of the scleral fibres at exposed sites in the sclera. The maximal stress of the horizontal recti and tractional forces of the muscles is at the insertions. Over time, these forces lead to thinning of the sclera and subsequent formation of scleral plaque.

In the absence of complications observation alone is advocated. Complications such as progression to scleral thinning[5] and sequestration of the plaque may occur. The former may lead to scleral perforation and the latter may be associated with infection. If these do occur, surgical management with scleral patch graft [5] may be required to preserve globe integrity and avoid further vision-threatening complications.

To summarise, this case demonstrates a fine example of a clinical situation where meticulous clinical examination and awareness of this condition can help avoid extensive systemic work up and unnecessary anxiety to the patient and the surgeon.



 
  References Top

1.
Watson P. Diseases of the sclera and episclera. In: Tasman W, Jaeger EA, editors. Duane's Clinical Ophthalmology . Philadelphia: Lippincott-Raven, 1997. Vol 4, pp 40.  Back to cited text no. 1
    
2.
Chandler JW. The sclera. In: Podos SM, Yanoff M, editors. Textbook of Ophthalmology. London: Mosby- Europe Ltd, 1994. Vol 8, pp 13-15.   Back to cited text no. 2
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3.
Donoso LA, Shields JA, Nagy RM. Epibulbar lesions simulating extraocular extension of uveal melanomas. Ann Ophthalmol 1982;14:1120-23.  Back to cited text no. 3
[PUBMED]    
4.
Soong HK, McKenney MJ, Wolter JR. Adrenochrome staining of senile plaque resembling malignant melanoma. Am J Ophthalmol 1986;101:380.   Back to cited text no. 4
[PUBMED]    
5.
Hillenkamp J, Sundmacher R, Sellmer R, Witschel H. Sequestrating senile scleral plaque simulating "necrotizing scleritis". Surgical management. Klin Monatsbl Augenheilkd 2000;216:177-80.  Back to cited text no. 5
[PUBMED]    
6.
Foster CS, de la Maza MS: Noninflammatory diseases of the sclera. In: Foster CS, de la Maza MS, editors. The Sclera . New York: Springer-Verlag, 1994. pp 283.  Back to cited text no. 6
    
7.
Scroggs MW, Klintworth GK. Senile scleral plaques: a histopathologic study using energy-dispersive x-ray microanalysis. Hum Pathol 1991;22:557-62.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure - 1], [Figure - 2]
 
 
    Tables

  [Table - 1]



 

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