Staphylomas.ppt

you will get information about the staphyloma, its types, its etiology, its pathogenesis and its treatment.
you will know about the clinical types of staphyloma in detailed such as anterior staphyloma, posterior staphyloma, equatorial staphyloma, ciliary staphyloma, and Intercalary staphyloma.

2. Staphyloma
Doctor of Optometry
AnamSehreen
By

3. Staphyloma
Localized bulging of weak and thin outer tunic of
the eyeball (cornea and sclera)which is lined by
uveal tissue which shines through the thinned out
fibrous coat.
It is an ectaticcondition of the sclera in which
uveal tissue is incarcerated

4. Pathogenesis
•As a result of continued high IOP, sclera
becomes very thin and atrophic and ultimately
bulges out either in the ciliary region (ciliary
staphyloma) or equatorial region (equatorial
staphyloma).

5. Etiology
•The intercalary, ciliary and equatorial
staphyloma are formed as a result of raised
intraocular tension and the degeneration and
thinning of scleral tissue.

6. Clinical types
Depending upon its location, scleral staphylomas
may be:
•Anterior staphyloma
•Ciliary staphyloma
•Intercalary staphyloma
•Equatorial staphyloma
•Posterior staphyloma

7. Different
staphylomas

8. Anterior staphyloma
The adherent leucoma becomes ectaticdue to
secondary glaucoma or weakness of corneal scar
tissue. The ectaticcicatrix in which iris is
incarcerated is called anterior staphyloma.
It is associated with ectasia of the cornea and
iris.
The most common cause is perforating corneal
ulcer or injury.
Marked corneal astigmatism

9. Anterior
staphyloma

10. Pathogenesis
•In a patient with sloughing corneal ulcer when
the whole cornea sloughs out, the inflamed iris is
covered with exudates.
•Ultimately these exudates organize and form a
fibrous layer over which the conjunctival or
corneal epithelium rapidly grows and thus a
pseudocornea is formed.

11. •Since the pseudocornea is thin and cannot
withstand the IOP, it usually bulges forward
along with the plastered iris tissue.
•This ectatic cicatrix is called anterior
staphyloma
Pathogenesis

12. A CASE OF ANTERIOR
STAPHYLOMA
Presenting symptoms.
Patient presents with:
Loss of vision
Bluish discoloration
Bulging
of the anterior part of the eye.

13. CASE
•History is suggestive of symptoms of corneal
ulceration (pain, redness, photophobia,
watering, loss of vision and whitish
discoloration) followed by the bluish
discoloration and bulging of the anterior part of
the eye.
•Examination reveals that cornea is replaced by
a lobulated ectatic scar tissue which is
blackened due to the iris plastered behind it

14. •Most of the times there is no chance of getting
useful vision in such eyes. Therefore, treatment is
carried out to improve the cosmetic appearance.
•Localized staphylectomy under heavy dose of oral
steroids may be carried out
•Evisceration is indicated in cases of bleeding
anterior staphylomas
Treatment

15. •After healing, cosmetic artificial shell may be
advised.
•In patient where there is a chance of getting
useful vision, keratoplasty or keratoprosthesis
may be performed.
Treatment

16. Intercalary staphyloma
It is the name given to the localised bulge in limbal
area lined by root of iris.
It lies between the iris and the ciliary body.
The most common cause is absolute glaucoma.
There may be associated secondary angle closure
glaucoma, which may cause progression of bulge if
not treated.

17. Intercalary
staphyloma

18. There is ectasia of sclera and root of iris. It
results due to ectasia of weak scar tissue formed
at the limbus, following healing of a perforating
injury or a peripheral corneal ulcer.
Defective vision occurs due to marked corneal
astigmatism.
Treatment consists of localised staphylectomy
under heavy doses of oral steroids.
Intercalary staphyloma

19. As the name implies, it is the bulge of weak
sclera lined by ciliary body. It occurs about 2-3
mm away from the limbus
There is ectasia of sclera and the ciliary body.
Its common causes are thinning of sclera
following perforating injury, scleritis and
absolute glaucoma
Cilliarystaphyloma

20. Ciliary
staphyloma

21. It results due to bulge of sclera lined by the
choroid in the equatorial region.
Causes:scleritis and degeneration of sclera in
pathological myopia.
There is ectasia of sclera and the choroid due to
absolute glaucoma.
It occurs more commonly at the regions of sclera
(unsupported by the muscles) which are
perforated by vortex veins (exit of vortex veins).
Equatorial staphyloma

22. •The sclera may bulge out at the posterior pole
due to thinning.
•It refers to bulge of weak sclera lined by the
choroid behind the equator.
•There is ectasia of sclera and the choroid
commonly in chorioretinaldegeneration due to
high myopia.
Posterior staphyloma

23. Posterior
staphyloma

24. Causes
•Common causes are
Pathological myopia
Posterior scleritis
Perforating injuries

25. It is diagnosed on ophthalmoscopy.
The area is excavated with retinal vessels dipping
in it (just like marked cupping of optic disc in
glaucoma).
Its floor is focused with minus number lenses in
ophthalmoscope as compared to its margin.
Diagnosis

26. Peripapillary staphyloma
•It is a non-hereditary, unilateral condition in
which a relatively normal disc sits at the base of a
deep excavation whose walls, as well as the
surrounding choroid and RPE, show atrophic
changes.
•VA is markedly reduced and local RD may be
present.
•Unlike other excavated optic disc anomalies, it is
rarely associated with other congenital defects or
systemic diseases.

27. Peripapillary
staphyloma

28. •Posterior staphyloma can be treated by
reinforcement surgery by fascia lata or silicon
band in cases of high myopia.
Treatment