The sclera is the protective outer layer of the eye. Scleritis is
a disorder in which the sclera becomes severely inflamed and red. The condition
can be very painful.
Scleritis is believed to be the result of the body’s immune
system overreacting. Which type of scleritis you have depends on the location
of the inflammation. Anterior scleritis occurs in the front of the eye, and
posterior scleritis occurs in the back of the eye. Most people feel severe pain
with the condition, but there are exceptions.
Treatment begins with the lowest risk option and progresses to
riskier options as the condition worsens. Your outlook depends on the type of
scleritis. In necrotizing scleritis, which is the most dangerous type, complete
or partial vision loss is common.
Are the Symptoms of Scleritis?
Severe eye pain that responds poorly to painkillers is the main
symptom of scleritis. Eye movements are likely to make the pain worse. The pain
may spread throughout the entire face.
Some people experience little to no pain from scleritis. This may
be because they have:
- a milder case of scleritis
- scleromalacia perforans, which is a rare
complication of advanced rheumatoid arthritis, or RA
- a history of using immunosuppressive medications
before their symptoms began
The symptoms of posterior scleritis include:
- deep-seated headaches
- pain caused by eye movement
- double vision
Other symptoms may include:
- lacrimation, or excessive tearing
- decreased vision
- photophobia, or sensitivity to light
There are theories that the immune system’s T cells cause
scleritis. The immune system is a network of organs, tissues, and circulating
cells that work together to stop bacteria and viruses from causing illness. T
cells work to destroy incoming pathogens, which are organisms that can cause
disease or illness. In scleritis, they’re believed to begin attacking the eye’s
own scleral cells.
Are the Risk Factors for Scleritis?
Scleritis may occur at any age. Women have twice the risk as men
for developing it. There’s no specific race or area of the world where this
disease is more common.
You have an increased chance of developing scleritis if you have:
- Wegener’s disease (Wegener’s granulomatosis),
which is an uncommon disorder that involves inflammation of the blood vessels
- rheumatoid arthritis (RA), which is an autoimmune
disorder causing inflammation of the joints
- inflammatory bowel disease (IBD), which is a disease
that causes digestive symptoms due to inflammation of the bowel
Are the Types of Scleritis?
Doctors use what’s called the Watson
and Hayreh classification to distinguish the different types of scleritis.
Classification is based upon whether the disease is affecting the anterior or
posterior of the sclera. The anterior forms are most likely to have an
underlying illness as part of their cause.
The subtypes of anterior scleritis include:
- diffuse anterior scleritis, which is the most
common form of scleritis
- nodular anterior scleritis, which is second most
common form of scleritis
- necrotizing anterior scleritis with inflammation,
which is the most serious form of anterior scleritis
- necrotizing anterior scleritis without
inflammation, which is the rarest form of anterior scleritis
Posterior scleritis is more difficult to diagnose. In this type,
the sclera inflammation is harder to detect because it has variable symptoms,
including many that mimic other disorders. Symptoms include severe irritation
of the eye and eye pain.
Is Scleritis Diagnosed?
Your doctor will review a detailed medical history, perform an examination,
and perform laboratory evaluations to diagnose scleritis.
Your doctor may ask questions about your history of systemic
conditions, such as whether you’ve had RA, Wegener’s granulomatosis, or IBD
They may also ask if you’ve had a history of trauma or surgery to the eye.
Other conditions that have symptoms similar to scleritis include:
- episcleritis, which is an inflammation of superficial
vessels in the outermost layer of the eye (episclera)
- blepharitis, which is an inflammation of the
outer eye lid
- viral conjunctivitis, which is an inflammation
of the eye caused by a virus
- bacterial conjunctivitis, which is an
inflammation of the eye caused by bacteria
The following tests can help your doctor make a diagnosis:
- They can use ultrasonography to look for changes
occurring in or around the sclera.
- They can get a complete blood count to check for
signs of infection and immune system activity.
- They can take biopsy of your sclera, which
involves removing tissue of the sclera so that it can be examined under a
Is Scleritis Treated?
Treatment of scleritis focuses on fighting the inflammation
before it can cause permanent damage. The treatment follows a stepladder
approach. If the first step in medication fails, then the second is used and so
Medications used to treat scleritis include the following:
- Nonsteroidal anti-inflammatory drugs are most
often used in nodular anterior scleritis.
- Oral glucocorticoids are the preferred choice
for posterior scleritis.
- Immunosuppressive drugs with oral
glucocorticoids are preferred for the most dangerous form, which is necrotizing
Is the Outlook for People with Scleritis?
Scleritis can cause significant eye damage. This disorder can also
result in partial to complete vision loss. When vision loss does occur, it’s usually
the result of necrotizing scleritis.