(1) The remaining chapters include discussions of tumors of the orbit, eyelid, conjunctiva, cornea and sclera , uvea, and optic nerve.(2) At the external border between the cornea and the sclera is the external scleral sulcus depression.(3) The limbus is the thin area that connects the cornea and the sclera , the white part of the eye.(4) Over the sclera lies the conjunctiva, a clear mucous membrane that protects the eye from becoming dry.(5) More anteriorly, the optic nerve is surrounded only by the smooth meningeal or inner layer of the dura, which blends with the sclera of the eyeball.(6) Physical exam reveals scleral icterus, an enlarged liver that is firm to palpation, and occasional splenomegaly.(7) The surgeon creates a scleral pocket by dissecting posteriorly, undermining the tissue with Wescott scissors.(8) In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina.(9) Surgical options include ulcer debridement, conjunctival resection, corneal graft, application of tissue adhesives, sclerectomy, and scleral patch grafting.(10) On examination, the patient appears nontoxic, is afebrile, has normal visual acuity, and demonstrates moderate bilateral conjunctival and scleral erythema, serous discharge, conjunctival swelling, and a tender preauricular node.
