Through the usually transparent conjunctiva, it is typically possible to directly inspect the limbus and the anterior sclera with the naked eye, but especially at the slit lamp. Subconjunctival hemorrhage, among other pathologies, however, can interfere with direct inspection of the sclera, making it necessary to use radiological tests (most importantly, CT), ultrasonography, or even exploratory surgery (see Chap. 1.9).

1 e.g., an improperly sutured anterior scleral or limbal wound can cause significant astigmia

2 As is the area at the insertion of the extraocular muscles (see Chap. 2.12)

Examining the posterior sclera is even more difficult. Taking a thorough history may provide some clues as can a detailed inspection using the slit lamp (see Fig. 2.4.1). Ultrasonography and CT may yield information that otherwise cannot be obtained, but if scleral integrity cannot adeqately be confirmed by these diagnostic tests, exploratory surgery becomes necessary.

Areas of thin sclera may be persent as a result of current trauma or surgery, past injury, autoimmune disease, or myopia. Extreme caution is necessary to avoid iatrogenic rupture (see below).

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