The most common collagen vascular disease association is with rheumatoid arthritis. These include collagen-vascular diseases (rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, systemic lupus erythematosus, reactive arthritis (formerly Reiter’s syndrome), relapsing polychondritis, ankylosing spondylitis, and pustulotic arthro-osteitis), vasculitides (polyarteritis nodosa, temporal arteritis, Cogan’s syndrome, Churg-Strauss syndrome, granulomatosis with polyangiitis, Behcet’s disease), dermatologic disease (rosacea, pyoderma gangrenosum, Sweet’s syndrome), metabolic disease (gout), and atopy. Approximately 26-36% of patients have an associated systemic disorder. Most cases of episcleritis are idiopathic. In contrast to simple episcleritis, nodular episcleritis has a less acute onset and more prolonged course. The episclera lies between the superficial scleral stroma and Tenon’s capsule. Both of the vessel networks originate from the anterior ciliary arteries, which stem from the muscular branches of the ophthalmic artery.
The deeper visceral layer contains a highly anastomotic network of vessels. The superficial vessels appear straight and are arranged in a radial fashion. The outer parietal layer, with the vessels of the superficial episcleral capillary plexus, is the more superficial layer. The episclera is a fibroelastic structure consisting of two layers loosely joined together. In simple episcleritis, vascular congestion is present in the absence of an obvious nodule. Nodular episcleritis is characterized by a discrete, elevated area of inflamed episcleral tissue. There are two forms of this condition: nodular and simple. Episcleritis is a relatively common, benign, self-limited inflammation of the episcleral tissues.
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