|Year : 1973 | Volume
| Issue : 3 | Page : 126-128
Bilateral ectasia of the sclera
KS Mehra, PN Roy
Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
K S Mehra
Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mehra K S, Roy P N. Bilateral ectasia of the sclera. Indian J Ophthalmol 1973;21:126-8
Scleral ectasia is quite uncommon. On going through the literature we find that till now only two such cases have been reported. Another case is being presented.
| Case Report|| |
A male patient, aged 72 years, attended with the complaint of painless sudden loss of vision in the left eye of one and half months duration.
Three years back, the patient had sudden loss of vision in the right eye for which he took treatment, but the vision did not improve and vision went on deteriorating.
RE - No light perception. Intraocular tension was 40 mm Hg. Schiotz, Rt. divergent squint with eccenteric fixation, Iris pattern was lost, multiple posterior synechia were present with cataract.
LE - Vision - hand movement close to face; the pupil was sluggish and round, tension, 18 mm Hg. Fundus showed presence of primary type of retinal detachment extending from 3 O'clock meridian to 8 O'clock meridian starting about one and a half disc diameter from the disc margin extending upto the periphery of the fundus. The detached retina was thrown into folds. No retinal holes could be seen.
Slit lamp: RE No K. P., no flare, iris pattern lost with presence of multiple post, synechia and mature cataract. LE - Nothing abnormal detected except presence of immature cortical cataract.
Gonioscopy- RE: showed multiple peripheral anterior synechia all through the angle. - Gr IV (Schies). Left eye - Grade II open (Schies).
The patient was given cortisone by mouth and also locally in the eye. After six days the vision improved to 4/60 in the left eye. All the investigations for the cause of uveitis were carried out and were negative.
A retinal detachment operation under GA was planned for the left eye. An incision 8 mm from the limbus was given in the conjunctiva from 1 O'clock to 8 O'clock meridian. On undermining the conjunctiva it was found that 3 blackish lines were running radially - anterio posteriorly. The anterior ends were about 10 mm from the limbus. The upper most line was running 3 mm above the upper margin of the lateral rectus and was 14 mm x 1 mm. Second line was running more or less parallel to the upper margin of the lateral rectus muscle, and was 14 x 2 mm in dimensions. The third line was running parallel to the lower margin of lateral rectus and was 7 x 1 mm in dimension. These lines had fine whitish coverings, through which uveal tissue was protruding out [Figure - 1]. The other areas in the sclera were searched but nothing could be found. These findings were never expected. Detachment operation with buckling was not possible with these findings hence the operation was postponed because scleral implant was not available.
For clinical interest the conjunctiva in the right eye was incised 8 mm all round the limbus. Five radiating lines were seen from 11 O'clock to 7 O'clock starting 10 mm from the limbus going backwards-the first line 4 mm x 1 mm, 2nd line 10 mm x 1.5 mm 3rd line 8 mm x 1.5 mm, 4th line 7 mm x 1 mm and 5th line - 5 mm x 1 mm. The distances between the lines were as follows:
Between 1st and 2nd - 4 mm, 2nd and 3rd - 4mm, 3rd and 4th - 2 mm, and 4h and 5th - 4 mm [Figure - 2].
Hence the diagnosis of ectasia of the sclera in both the eyes was made.
| Discussion|| |
DUKE ELDER  is of the opinion that stretching of the sclera may occur even with normal intraocular pressure if the scleral resistance has been lowered by a congenital defect or a pathological lesion. In ectasia of the sclera it is the involvement of sclera only without inolvement of uvea. Ectasia can be total or partial. Partial ectasia or staphyloma can be congenital in origin as seen in myopia while the postnatal type is only partial. According to DUKE ELDER an ectasia may also appear in the equatorial region or in the region of the attachments of horizontal rectus muscles in absence of inflammation and is due to some nutritional or degenerative condition. VAIL  and LiscH  have reported two cases who had symmetrical bilateral ectasia in the temporal equatorial region of the eyeball.
Our reported case also fits into the same diagnosis though he also showed uveitis in the right eye. In the left eye this picture can also result either due to sarcoma of the choroid going into the extraocular extension stage or can be as a result of thinning of scleral due to recurrent attacks of scleritis. The possibility of malignancy was not there because the intraocular tension was normal and secondly retinal detachment was recent and of sudden origin and that even of primary type, while as a result of old scleritis was also ruled out because the patient had no history of recurrent attacks of scleritis. The findings in the right eye can be explained on the basis that the patient developed retinal detachment as a result of scleral ectasia giving rise to uveitis and secondary glaucoma.
DUKE ELDER , has further reported that such patients have visual failure due to retinal detachment and equatorial ectasia is discovered on the operating table when surgery for retinal detachment has been planned.
| Summary|| |
An interesting case, of a man aged 72 years, having bilateral multiple symmetrical scleral ectasias in the region of temporal equator of the eye balls is being reported.
| References|| |
Duke Elder: System of Ophthalmology, Henry Kimpton, London, 1964, Vol. 3, Part II, p. 542.
Duke Elder: System of Ophthalmology, Henry Kimpton, London, 1965, Vol. 8, Part II, p. 1002.
Vail: Amer. Jour. Ophth., 29: 785, 1946, quoted by Duke Elder in 2.
Lisch: Ber dtsch. Ophthal., Ges. 55: 402, 1949, quoted by Duke-Elder in 2.
[Figure - 1], [Figure - 2]