67 yrs/m , c/o pain ,redness in eye for 15 to 20 days .H/o instilling some eye drops but no improvement . eye is aphakia for 2 yrs . There is no trauma. dx & rx ?

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Thus is a case of acute nodular scleritis . Rx : - oral steroid , oral nsaid . - topical nsaid . - atropine e/drops . Pt is asked for f/up after 2 days , that is tomorrow.

No topical steroids?
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Phlectenular conjunctivitis, treat with Antibiotic steroid eye drops 2 hourly, Lubricants, Antibiotic steroid eye ointment HS

There is no ulceration of lesion even after 15 to 20 days . The lesion appears to be too big to be a phlycten.
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What is this yellowish patch, some deposition scarring or avascularity (? Necrotizing)

Yes , yellowish area is elevated lesion . It appears to be avascular . It is more likely to be necrotizing type with inflammation.
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Modular episcleritis

This looks like a scleral abscess if it's happen for the 1st time but if it's a case of repeated episode then a case of episcleritis. Treatment of both the cases are different and opposite . Scleral abscess.... Broad spectrum antibiotic like augmentin in higher dose. 2. Acelofenac + paracetamol+ serratiopeptidase combination One tab tds 3. Cap B complex If necessary I &D can be a choice also. Episcleritis..... Steroid and antibiotic combination eye drop , one drop 4 time a day. 2. Nepafenac eye drop one drop 3 times a day 3. Tab analgesic as per the need 4.Tab Vit C 5. Investigation to r/o tuberculosis and other systemic infective disease .

Pingueculitis?

I had written for phlictinular conjunctivitis .
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There was a belief that this may a allergic manifestation of tubercle protein

This is not phlyctenular conjunctivitis .
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Looks Ischemic area surrounded by conj conj .IOP check and topical steroids

The lesion is nodular & yellowish surrounded by congestion .
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Nodular sclerotia . Treat with steroids systemic and local and antibiotics .

Sclerotia not sclerotia
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Sub conj. Hemorrhage

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