scleral buckle icd 10. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. scleral buckle icd 10

 
 It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure successscleral buckle icd 10  Indeed, encirclement has been used without any

Scleral buckle: A piece of silicone rubber or sponge sutured to the outer wall of the Anat Loewenstein, MD eye posterior to the rectus eye muscles. Schisis detachments may develop in a small (<10%) of eyes with schisis. Code Descriptor and Instructional Notes. The scleral buckle helps to indent the eye to sup-port the peripheral retina and pushes the outer eye against the retina in eyes with a retinal detachment. 8 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail. The eye was reexamined. CPT code 67120 (removal of implanted material, posterior segment; extraocular) should be used for coding removal of a scleral buckle. 8 may differ. Other disorders of sclera. 70 RVUs. CPT codes 67120 and 67121. 053 Disease. E08. 019 - other international versions of ICD-10 H33. 4). The 2024 edition of ICD-10-CM H33. This is the American ICD-10-CM version of M85. It is a method of closing breaks and flattening the retina. 021 Response Feedback: There is one CPT® code and one ICD-10-CM code. Comment to photo: An encircling band after a buckling procedure has worked itself forward and is fully exposed. Applicable To. 51 - Corneal grft malfunction: Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code. The basic ICD-10-CM diagnosis for each code is as follows: H35. The 2024 edition of ICD-10-CM H33. This is the American ICD-10-CM version of H52. 3 Etiology;. 841. The 2024 edition of ICD-10-CM H33. Annotation Back-References. 89 is a billable diagnosis code used to specify other disorders of sclera. Upon examination on presentation, visual acuity was 20/125 in the right eye and no light perception in the left eye. The following code(s) above C44. 811 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 1. Code Also. School American Academy of Professional Coders; Course Title CODING CPC; Uploaded By DUCHESSBLUE. Diseases of vocal cords and larynx, not elsewhere classified. Type 1 Excludes. Code as 67108 only as the CPT descriptor does include the scleral buckle. A scleral buckle is a surgery that places a permanent silicone band around the eye to help return the — a thin layer of tissue located in the back of the eye — into position after a retinal detachment. ICD-10-PCS Root Operation Definitions This resource is a compilation of all root operations inDec 20, 2017. Scleral buckling is a surgical technique that is employed successfully to treat rhegmatogenous retinal detachments (RRD) for more than 60 years. The listing for H33. Persistent subretinal fluid (PSF) was. After administration of lidocaine, I performed a shave biopsy. ICD-10-PCS code: 08RK3JZ. The fluid is reabsorbed naturally by the RPE pump. 122 contain annotation back-references. 2016. NON-BILLABLE | ICD-10 from 2011 - 2016. In this retrospective comparative case series at a teaching hospital, we reviewed adult patients with rhegmatogenous retinal detachment who underwent scleral buckling surgery with external drainage of subretinal fluid performed before versus after placement of the scleral buckle. The pupils are dilated (made bigger) with eye drops. If the patient has Medicare Part B, this code isn’t bundled with 65285, 67311, 67930, or 67935. In normal eyes, retinal detachment (RD) occurs at a rate of approximately 5 per 100,000 people per year and the frequency of proliferative vitreoretinopathy (PVR) remains largely unchanged in primary RD, with the incidence ranging from 5. This is the American ICD-10-CM version of H33. Therefore, this diagnosis. Proliferative vitreoretinopathy (PVR) is classified using the following International Classification of Disease (ICD) code: H35. ICD-9-CM 379. [1][2][3] Symptoms of scleritis can involve focal or diffuse hyperemia, pain, and visual impairment. 20, other non-diabetic proliferative retinopathy, unspecified eye. Wong V, Kasbekar S, Young J, Stappler T, Marsh IB, Durnian JM. 842 ICD-10 code H15. 32 (non-billable); retinal breaks without detachment ICD-10 H33. 2-); Rhegmatogenous retinal detachment. The above description is abbreviated. ) The inferior nasal suture was tied down over the scleral buckle and all knots were rotated posteriorly. 1095 or 800. Scleral buckling surgery allows a surgeon to reattach a person’s detached retina. The buckle-induced indentation aids in adhesion between the neurosensory retina and the retinal pigment epitheli­um, while relieving vitreous traction on the retina. June 1, 2020. 89 to ICD-9-CM. Type 2 Excludes 67108. This is the American ICD-10-CM version of H15. A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS)Right scleral ectasia; Right scleral ectasia (eye condition) ICD-10-CM Diagnosis Code H15. Management of rhegmatogenous retinal detachment with macula detached. Additional/Related Information. Culture of the protruded segment. 842 for Scleral ectasia, left eye is a medical classification as listed by WHO under the range - Diseases of the eye and adnexa . FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set) Previous Code: T85. Despite the lower single operation success rate, the functional outcomes of those eyes repaired successfully by primary PR exceed those of scleral buckling (SB) and pars plana vitrectomy (PPV). 37,38 The discomfort, poor refractive outcomes and tissue erosion caused by scleral buckles can be avoided with vitrectomy alone without compromising outcome. Welcome to scleral buckling 101 for the senior ophthalmology resident and the junior retina fellow! Rhegmatogenous retinal detachment (RRD) repair is one of the most common indications for retinal surgery. 4. (The postoperative diagnosis is used for coding. 52 RVUs, respectively, and are not bundled with 65285, 67311, or 66020. 009 became effective on October 1, 2023. The 2024 edition of ICD-10-CM H31. Answer: You are correct. By far the most common complication of scleral buckling surgery is retinal redetachment, which may be as high as 47% in the first year. Q13. Scleral buckling is preferred in retinal detachment due to lattice with holes or retinal dialysis in a young individual. The scleral patch graft procedure is intended for cases of scleral thinning, such as in the present case. Scleral buckling with exogenous material is an effective and important method to reattach the retina. 398A contain annotation back-references Scleral ectasia, right eye. Use of special retinal detachment repair strategies, including retinectomy or perfluorocarbon liquid, may be necessary in patients with. Diabetes mellitus due to underlying condition with proliferative diabeticAnatomic success was achieved in 84% of vitrectomy-only cases and in 92% of combination procedures (p = . 37,38 The discomfort, poor refractive outcomes and tissue erosion caused by scleral buckles can be avoided with vitrectomy alone without compromising outcome rates. Anatomic success was not affected by the type of gas tamponade or the gauge of in­strumentation. Use CPT code 68200–58–eye modifier and J9190 for fluorouracil. Veteran coders were accustomed to using now-deleted code 67112 (Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair [s] using scleral buckling or vitrectomy. 14. 500 results found. 41 - Scleral buckling with implant. 841 became effective on October 1, 2023. The code is exempt from present on admission (POA) reporting for. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when. FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. Scleral ectasia, right eye. 843 [convert to ICD-9-CM] Scleral ectasia, bilateral. 19 should only be used for claims with a date of service on or before September 30, 2015. 398A became effective on October 1, 2023. 3–24. This procedural combination of vitrectomy, membrane peeling and scleral buckle is done to alleviate the retinal traction in PVR and facilitate retinal flattening. 019 became effective on October 1, 2023. S05. Stata 8 statistical software. CPT code 67115 (Release of encircling material, posterior segment) is usually used for releasing tension. Diseases of the eye and adnexa. H55-H57 Other disorders of eye and adnexa. CPT code 67120 (removal of implanted material, posterior segment; extraocular) should be used for coding removal of a scleral buckle. ICD-10-CM Codes › H00-H59 › H15-H22 › Disorders of sclera H15 Disorders of sclera H15- Clinical Information. 1. Scleral buckling surgery is a common way to treat retinal detachment. 0. 001 may differ. 009 [convert to ICD-9-CM] Unspecified scleritis, unspecified eye. This is the American ICD-10-CM version of D47. A type 1 excludes note indicates that the code excluded should never be used at the same time as T59. This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. 89 RVUs and is not bundled with 65285, 67930, 67935, or 66020. The aim of this study is to report the complications of SCB and to propose measures to decrease. 103: Unspecified chorioretinal inflammation bilateral. Images obtained from patient with an infected scleral buckle. Disorders of sclera (H15) Other scleritis, unspecified eye (H15. Tabs. Your eye doctor may leave the buckle in place for six months to 10 years, depending on the support your retina needs. 68 results found. Codes; Modifiers; License Data Files; Disclaimer; Search Results. The most common indications for removal of a scleral buckle are buckle infection and buckle exposure [2, 5], with their incidence ranging from 0. 10 Repair of a detached right retina by means of an encircling procedure and including scleral dissection, implant, cryotherapy, and drainage of subretinal fluid CPT Code: 67107-RT (Retina, Repair, Detachment, Scleral Buckling) ICD-10. A buckle is used after a. 379 - other international versions of ICD-10 H35. ICD-10-PCS 0NR00JZ is a specific/billable code that can be used to indicate a procedure. ) PROCEDURE: Scleral buckle, cryoretinopexy, drainage of subretinal fluid, C3F8 gas in the right eye. ICD-10-CM Range H15-H22. Infants with Stage V ROP have total retinal detachment with very poor visual prognosis. H33. 122 - other international versions of ICD-10 C44. ICD-10. ICD-10-CM Diagnosis Code Q13. 093 [convert to ICD-9-CM] Other scleritis, bilateral. 01 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 001 - other international versions of ICD-10 H15. ICD-9-CM Vol. The current study was a prospective randomized clinical trial. and as a postoperative finding from scleral buckle surgery, blepharoplasty, orbicularis myectomy, and glaucoma filtering operation with prominent bleb. 3 may differ. 3mm and 14. Check out the following three steps to determine how to code this procedure note. 059 became effective on October 1, 2023. A code also note instructs that 2 codes may be required to fully describe a condition but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for. 89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Journal Highlights. Short description: Malfunc oth device/graft. Scleral buckle (SB)-related complications include induced myopia, diplopia, foreign body sensation, infection, extrusion, and intrusion [1-5]. 1 • Nodular scleritis is characterized by a localized area of inflammation where a distinct nodule can be seen. Disorders of sclera, cornea, iris and ciliary body H15 Disorders of sclera; H16 Keratitis; H17 Corneal scars and opacities;. However, this can be distinguished from aqueous misdirection by its moderate, non-progressive features. 5%, 19 patients) of the vitrectomy group appeared during the first 124 days (4. 89 became effective on October 1, 2023. A disorder affecting the sclera. 1 Despite this, scleral buckling remains an essential skill for vitreoretinal surgeons, offering potential advantages to vitrectomy. A, The arrow points to an exposed, infected scleral buckle. 811 became effective on October 1, 2023. Furthermore, because the convex radius of curvature of the retina on the scleral buckle is much smaller than the concave radius of curvature of. MIRAgel (MIRA, Waltham, MA) is a hydrogel buckle that was introduced in 1979 as a new scleral implant for the treatment of retinal detachment. en Change Language. It involves closing any breaks in a person’s retina and making sure it remains attached after surgery. 1. The left eye underwent scleral buckling procedure with placement of 360° encircling explant followed by vitrectomy. ICD10-Code:Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT® code. Scleral buckling (SB) plus pars plana vitrectomy (PPV) for repair of rheg­matogenous retinal detachments (RRDs) remains controversial. Scleral buckle surgery, or scleral buckling, repairs a retinal detachment. ICD-9-CM Vol. Vision return depends on so many factors. H11. This part of the eye is called the sclera. This is either because of missed breaks, inadequate or misplaced buckles, or inadequate retinopexy. ICD-10-CM Code Description . Data gathering only. Methods: Retrospective multicenter orbital computed tomography (CT) study of 14 patients and brain magnetic resonance (MR) in one patient with scleral buckle infections, some with the referring diagnosis of. Prior to initiating scleral depression, the patient should be fully dilated. This was the first year ICD-10-CM was implemented into the HIPAA code set. Download PDF. 1097/01. 842 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The eye was reexamined. Regarding the scleral buckle group, 10. A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Bilateral scleral ectasia; Scleral ectasia, both eyes. To report see 67107, 67108, 67110, 67113. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of. I expose the sclera 360º degrees, move away the conjunctiva, and place a silicone scleral buckle around the eye. Code Deleted. It may also be performed using contact lens biomicroscopy and may use scleral depression. A scleral buckle is performed to repair a retinal detachment by reestablishing the anatomic proximity of separated retina from its underlying tissue. The scleral buckle reverses the direction of the radial force induced by the epiretinal membrane from an inward force, tending to detach the retina, to an outward force, promoting retinal reattachment. H53-H54 Visual disturbances and blindness. (Sclera buckling is performed. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM. PROCEDURE: After the. H59. 51 Repair of retinal detachment with diathermy convert 14. 009 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 89 is grouped within Diagnostic Related Group(s) (MS-DRG v 41. 3531 . 1 Introduction; 2 Disease Entity. 219A became effective on October 1, 2023. Comment to photo: An encircling band after a buckling procedure has worked itself forward and is fully exposed. Paul Sullivan, in Retina (Fifth Edition), 2013. Scleral ectasia, left eye. of vitrectomy; Hx of yag laser capsulotomy;. 398A may differ. Mean follow‐up was 37 ± 35 months. Local ischemia can be induced by strabismus surgery, par­ticularly in multiple muscle surgeries, and scleral buckling procedures (overly tight buckles with multiple sutures) and excessive use of cautery. 099. Scleral buckling surgery is a common way to treat retinal detachment. This is the American ICD-10-CM version of H44. 11. The retina is a layer of cells at the back of your eye. 009 - other international versions of ICD-10 H15. Scleritis is an inflammation of the sclera, the outer layer of the globe. 1. Figure 86. ) PROCEDURE: Scleral buckle, cryoretinopexy, drainage of subretinal fluid, C3F8 gas in the right eye. PREOPERATIVE DIAGNOSIS: Retinal detachment, right eye. This technique might be useful in minimizing retinal displacement in patients with retinal detachment and. I expose the sclera 360º degrees, move away the conjunctiva, and place a silicone scleral buckle around the eye. 51 - Corneal grft malfunction: Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code. There are several reports on explantation of SB for various indications [1,4,6-13]. The retina is a layer of tissue located inside the eye. 3 Procedure Codes. 19 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 379. S05. To describe four patients with an enlarging orbital mass from a swollen MIRAgel scleral buckle that simulated an orbital neoplasm. 41 Scleral buckling with implant. MIRAgel scleral buckle material can greatly enlarge over a period of 10 years and simulate an. The 2024 edition of ICD-10-CM H15. This is the American ICD-10-CM version of H31. I review the pertinent literature in an effort to develop guidelines for when to remove a SB. Scleral rupture during retinal detachment (RD) repair is a rare occurrence. Tie a knot snugly (but not too tight) so that the suture is attached to the IOL haptic. exposed scleral buckle following cataract surgery, explantation of scleral buckle and trauma. The buckle-induced indentation aids in adhesion between the neurosensory retina and the retinal pigment epitheli­um, while relieving vitreous traction on the retina. Outer wall breaks have a 10-27% incidence and usually can be observed. The 2024 edition of ICD-10-CM Z98. 41 60 SEC. The use of scleral buckles (SBs) to repair rhegmatogenous retinal detachments (RRDs) was pioneered by Custodis in 1949, with the first reported scleral buckling procedure performed in the United States in 1951 by Schepens. 2024 ICD-10-CM Range H00-H59. Contact Information. ICD-9-CM: 14. Search All ICD-10; ICD-10-CM Diagnosis Codes; ICD-10-PCS Procedure Codes; ICD-10-CM Diagnosis Index; ICD-10-CM External Causes Index;. Any non-absorbable scleral suture was cut and removed. Contents. Veteran coders were accustomed to using now-deleted code 67112 (Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair [s] using scleral buckling or. View in Article Google Scholar; Abu Eleinen K. This is the American ICD-10-CM version of T85. Learn more about procedures in the Coding Coach. % Change in Office Pay 2020-21. ”. SUGGESTED. During encircling scleral buckle placement, the ends of the element/band are tightened in order to achieve a shortened radius of the eye at the place of the buckle. This is the American ICD-10-CM version of H15. ICD-10-PCS Procedure Code 08R7XKZ [convert to ICD-9-CM] Replacement of Left Sclera with Nonautologous Tissue Substitute, External Approach ICD-10-CM Diagnosis Code Q13. In such cases the scleral buckle must be removed which brings with it the risk of retinal. nasal sutures were tied down over the scleral buckle. 00 - D57. 89 may differ. A Paparella style tube was placed. The surgeon removes a scleral buckle. Related. such as pars plana vitrectomy or scleral buckle. This is the American ICD-10-CM version of H15. 001 PMID: 22516538 > Crossref Medline Google Scholar; 10. Showing 1-25: ICD-10-CM Diagnosis Code H15. S40. 043 [convert to ICD-9-CM] Retinal detachment with retinal dialysis, bilateral. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM. Although the majority of scleritis cases are due to an autoimmune etiology, approximately 5 to 10% of. A scleral buckle is one of several ophthalmologic procedures that can be used to repair a retinal detachment. 00XA is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. This section shows you chapter-specific coding guidelines to increase your understanding and correct usage of the target ICD-10-CM Volume 1 code. REPAIR OF RETINAL DETACHMENT WITH SCLERAL BUCKLING AND IMPLANT. 67108 Repair of retinal detachment; with vitrectomy, any method including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of. 8. The material is sewn to the. H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction. POSTOPERATIVE DIAGNOSIS: Retinal detachment, right eye. However, he did do a scleral buckle, but the only. Retinal detachment happens when the retina, a. ICD-10-CM Diagnosis Code H15. The procedure derives its name from the fact that vitreous is removed. 092 - other international versions of ICD-10 H15. Scleral buckling (SB) remains an important technique to master for those interested in treating rhegmatogenous retinal detachment (RRD). ICD-10-CM Diagnosis Code H15. D. Prophylactic 360-degree peripheral laser photocoagulation was. f5. Short description: Disorder of sclera NEC. 2 Etiology; 1. Schepens CL. Author Information and Affiliations Last Update: May 29, 2023. [1,2,3,4] Few uncommon complications were reported after SB surgery, such as buckle expose, infection, diplopia, buckle migration,. The 2024 edition of ICD-10-CM H44. I take down the conjunctiva 360º degrees around the cornea at the limbus to isolate the sclera. 841 may differ. Methods: Twenty eyes of 20 consecutive patients with primary inferior RRD and PVR >or=CP2 were alternatively assigned to PPV and. Q. (Sclera buckling is performed. The ratio of scleral buckle operations to RRD admissions changed from 84:100 in 2000–01 to 7. Hx of scleral buckling with vitrectomy; Hx of selective laser trabeculoplasty; Hx of simple. 41 to ICD-10-PCS; 14. 78 and 12. Disease or Syndrome. Sometimes the silicone rubber piece erodes through the conjunctiva and can become infected. Retinal detachment with retinal break. The conjunctiva breaks down over the silicone rubber explant. Showing 26-50: ICD-10-PCS Procedure Code 08R6 Sclera, Right ICD-10-PCS Procedure Code 08R7 Sclera, Left ICD-10-CM Diagnosis Code H59. Scleral Buckling Piyush Kohli; Koushik Tripathy. 328A: 996. 1281 suture scleral lacer 1432 retinal tear cryotherapy 1439 retinal tear repair nec 1441 scleral buckle w implant 1449 scleral buckling nec 1451 detach retina-diathermy 1452 detach retina-cryotherap 1453 detach retina xenon coag 1454 detach retina laser coag 1455 detach ret photocoag nos 1459 repair retina detach nec 146 remov pros mat post segBackground and objective: To report indications, timing, complications, and outcomes of scleral buckle (SB) removal surgery. Medical records of the 137 randomly selected patients were analyzed and all relevant patient characteristics were compared. 7% vs. Short description: Disorder of sclera NEC. The tears were supported on the scleral. Patients with PVR-associated failure were more likely to be smokers (P < 0. 5 may differ. 67028. Nov 15, 2023. Two The placement of the scleral buckle and the retinopexy 1. ICD-10-CM Diagnosis Code H15. 70 RVUs. ICD-10: H15. The 2024 edition of ICD-10-CM H11. 89 became effective on October 1, 2023. 4. PROCEDURE: After the. Secondary corneal edema, bilateral. kernicterus ( P57. 74: MeSH: edit on Wikidata] Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye. 1016/s0161-6420 (86)33552-8. S. 23 may differ. 059 may differ. Synonyms: acquired scleral show due to eyelid deformity, anterior sclera finding, Background Multiple surgical techniques exist for the repair of rhegmatogenous retinal detachments (RRD). W. 67930 and 67935 have 6. 0000148409. He chooses from various techniques, such as lamellar scleral dissection (separation of the sclera in layers), imbrication (overlap opposing tissues), or encircle the retina with sutures. 019 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. All Available Newsletters;. !!This procedure, called scleral (SKLAIR-ul) buckling, involves the surgeon sewing (suturing) a piece of silicone material to the white of your eye (sclera) over the affected area. In most cases this is secondary to an underlying etiology. Methods: A retrospective study of 28 consecutive cryobuckle procedures for retinal detachments secondary to retinal dialysis is reported, with particular attention directed towards postoperative complications relating to the buckle. H33. H15. 89. Author Information and Affiliations Last Update: May 29, 2023. Search Page 3/3: scleral buckle Search Results 68 results found. The band will stay on your eye permanently after the surgery. Scleral Buckling Piyush Kohli; Koushik Tripathy. The surgeon removes a scleral buckle. 65210 removal embedded conjunctival/scleral nonperforating 65220 removal, corneal without slit slamp 65222 removal, corneal with slit lamp 65235 removal, intraocular, anterior chamber or lens 65270 repair laceration conjunctiva w-w/o direct closure 65272 repair conjunctiva mobilization & rearrange w/o hospital Scleral buckle removal: indications and outcomes. Immediate surgical intervention includes foreign body removal, globe exploration, pars plana vitrectomy, scleral buckle, enucleation, etc. 41 Scleral buckling with implant 42776 -00 Repair of retinal detachment with scleral bucklingTantalum was first utilized in scleral buckling in the late 1960s and early 1970s. Bilateral scleral ectasia; Scleral ectasia, both eyes. A cut is made over the outer layer of the eye, the sclera.