Scleritis is a painful and potentially severe inflammation or swelling of the sclera. The sclera is the white area of the eye, also referred to as the white of the eye.
The sclera forms about 83% of the surface of the eyeball. It is a tough, fibrous tissue that makes up the outer protective layer and gives the eye its shape.
There are two primary forms of scleritis:
- Anterior scleritis- It is the more common type and affects the front area of the eye. It has three subtypes:
- Diffuse scleritis- It is the more prevalent type. It is characterized by inflammation throughout the front section or the whole of the sclera.
- Necrotizing scleritis is the more severe form of anterior scleritis.
- Nodular scleritis forms bumps or nodules on the sclera.
- Posterior scleritis is a rare type of eye disease and affects the back part of the eye.
Causes and Risk Factors
Eye infections or autoimmune disorders can cause scleritis.
About half of the incidences of the eye condition are linked to an underlying autoimmune disease. The immune system protects the body against bacterial, viral and other invasions. Autoimmune disorders may cause the system to attack healthy parts of the body by mistake.
Rheumatoid arthritis, inflammatory bowel syndrome (IBS) and lupus are some examples of autoimmune diseases.
Posterior scleritis can occur with the anterior types of scleritis or on its own.
In some cases, the cause is unknown.
Scleritis risk factors include:
- People aged between 30 and 60
- Eye trauma
- Sjogren's syndrome
- Eye infection
- Inflammatory bowel disease
- Certain connective tissue disease
- Different forms of inflammatory arthritis
- Wegener's granulomatosis
Signs & Symptoms
Scleritis symptoms may include:
- Inflammation and redness of the white section of the eye
- Eye irritation
- Blurred vision
- Sensitivity to light
- Reduced vision
- Watery eyes
- Double vision
- Loss of sight, partial or complete
- Severe eye aching or pain and tenderness which may spread to other parts of the face and jaw
The eye care professional may diagnose scleritis by taking the patient’s medical history and conducting a comprehensive eye exam. The tests may include:
- Dilated eye exam
- Tonometry to check internal eye pressure
- Refraction test for people who wear glasses
- Vision test
- Slit lamp exam to look at the inner eye structures
- Fluorescein angiogram
Scleritis is often associated with other medical conditions. The professional may recommend a more comprehensive medical exam such as:
- Blood test
- CT scan
- Magnetic resonance imaging (MRI)
He/she may have to work with the patient’s primary care doctor or other experts, such as a rheumatologist, to determine any underlying cause(s).
Treatment is aimed at preventing scleral damage and vision loss.
Treatment of scleritis varies depending on the type of the disease. The eye doctor may prescribe:
- Nonsteroidal anti-inflammatory drugs (NSAIDs in minor cases of nodular anterior scleritis
- Oral glucocorticoids for posterior scleritis
- Corticosteroid medication for inflammation, eye pain and protecting vision
- Antibiotics for scleral infections
- Antifungal medications for infections caused by Sjogren’s syndrome
- Immunosuppressive drugs with oral glucocorticoids for necrotizing scleritis
Where another medical disorder causes scleritis, treatment of the underlying disease is necessary to manage scleritis symptoms.
In severe cases of scleritis, the eye surgeon may need to use surgery to prevent further loss of vision and repair scleral tissues (scleral graft).
It is important to note that scleritis is a serious disease that can lead to loss of vision. Posterior scleritis can lead to complications that may further cause angle-closure glaucoma and retinal detachment.
Necrotizing scleritis can destroy the scleral membrane. In rare cases, it can lead to loss of the eye.
Scleritis may return even after treatment. The patient needs to follow up with the eye doctor and other experts at treating and controlling it.
- Using protective eyewear can prevent eye injury
- Maintaining good hygiene may prevent parasite, fungal and other eye infections
- It may not be preventable in other cases