Acute/recurrent/chronic. 20-50 yo. 3rd most common orbital disease in adults.Unilateral, suddenonset of PAIN, red eye, dipl. Bilateral (30% of kids), (50% of kids-> +fever, nausea, vomiting). [Signs] Proptosis, EOM restriction, hyperopic shift,optic nerve swelling, reduced corneal sensation 2^ CN V1 involvement. [dx] Idiopathic/inflammatory process-> any soft tissue in orbit. Females, Anterior scleritis (98%): either diffuse (40%), Nodular (44%), necrotizing (14%) w/ or w/out inflammation. 25% die without proper treatment. Necrotizing w/out inflammation Scleromalacia Perforaus, 2^ Chronic RA. [Sx] SEVERE ocular pain and BILATERAL, can extend to forehead, and cause decrease VA (Except Scleromalacia Perforaus, instead asymptomatic). [Signs] Edematous/thin sclera (classic bluish hue under natural light ). [Patho] Granulomatous infllamation of sclera, 50%= underlyin systematic disease. 30% collagen vascular disease, Wegner's granulomatosis). HZO, Acne Rosacea, Sarcoid, TB, Syphilis, topical meds (NSAIDS, corticosteroids, Gout) Granulomatous: grainy surface, blurred VA, mild pain, mild photophobia think Syphilis, TB, Sarcoid. Non-Granulomatous: Acute onset, pain, extreme in sx think of Ankylosing spondylitis, Reiter's syndrome, Inflammatory bowel disease, Bechet's, Lyme, Glaucomatocyclitis Crisis, viral infection, trauma, AI. Absolute= <21 yo, refractive instability, KC, CL warpage, immunosuppressive, infection, CT disease, unrealistic expectations. VS Relative= DES, bleph, chronic eye rubbing, ocular surface disease, DM, GLC. CRVO, BRVO, CRAO, BRAO, DR, HTN REtinopath, Retinal Artery Macroaneurysm, Ocular Ischemic Syndrome, Idiopathic Juxtafoveolar Retinal Telangiectasia, Coats Disease, ROP. *ask about transient ischemic attacks of visual BLACKOUT/BLUR (amaurosis fugax). Older pts, w/ HTN (67%), DM (33%), CVD (25%) and cardiac valve disease (25%). [Sx] Acute, profound VA loss, unless cilioretinal artery is sparing the macula. [Signs] +APD, cherry red spot, narrowed arterial vasculature, Hollenhorst plaques/emboli. [Patho] Plauques/emboli. Other cause: GCA, Collagen Vascular disease, Sickle cell. *ask h/o intraocular surgery, previous uveitis, ocular/systemic conditions that can cause intraocular inflammation.[Sx] Metamorphopsia, decreased VA. [Signs] Loss of foveal reflex, foveal thickening (+/- intraretinal cysts) [Patho] Surgery, DR, Retinal Vein occlusion, Uveitis, RP, ARMD, Coat's Retinal Vasculitis. non-heritable or heritable (AD common), or w/ systemic disorder; Usher's (5% of RP). most common Retinal Dystrophy). Dx @ 9-19yo. [Sx] Night blindness, tunnel vision, years-decades for sx to develop. By 30 yo: >75% are symptomatic. [Signs] Triad= retinal bone-spicule pigmentation midperiphery, arteriolar attn, waxy opic disc pallor. PSC, optic drusens, macular changes ( atrophy, CME, ERM's), KC, myopia, progressive contraction of VF "tiny island of central vision" that may be lost.[Patho] Progressive loss of RPE and PR fxn. ERG- scotopic reduced, photopic relative normal.