Scleritis: Symptoms, Risks, and Treatment Options for Eye Inflammation

Scleritis is an intense inflammation of the eye's protective layer, requiring prompt diagnosis and careful management by eye care professionals. Contact top specialists through Specialty Vision for personalized care.

Table of Contents

Scleritis: Understanding a Serious Inflammatory Condition of the Eye & What Is Scleritis and Why Is It Important? & Types and Classifications of Scleritis & Anterior Scleritis & Posterior Scleritis & Recognizing Signs, Symptoms, and Risk Factors & Signs and Symptoms to Recognize & Pain

Scleritis is a severe inflammation of the sclera, the white, protective outer layer of the eye, that can be both painful and vision-threatening. This condition is not only distressing but may also signal an underlying systemic disease such as rheumatoid arthritis, lupus, or other autoimmune disorders. Recognizing and treating scleritis promptly is essential to prevent potential long-term damage and preserve vision.

Scleritis is an inflammation that affects the deep episcleral and scleral tissues, often producing a distinctive violet-bluish hue and significant eye pain. Our eye doctors explain that patients with scleritis usually report a deep, aching pain that may radiate to the face, jaw, or head, and the discomfort often worsens with eye movement. This painful condition is far more than a simple red eye, it can indicate serious underlying systemic involvement that needs careful evaluation and long-term management.

Anterior scleritis is the most common form and involves the sclera in front of the extraocular muscles. It can be further split into distinct subtypes:

  • Diffuse Anterior Scleritis: In this type, inflammation spreads across a wide area of the sclera, often accompanied by a generalized deep redness and edema.
  • Nodular Scleritis: This presents as one or more distinct, tender nodules on the scleral surface. The localized swelling and intense pain are hallmarks that help our eye doctors differentiate it from less severe conditions.
  • Necrotizing Scleritis: This is the most severe form, characterized by areas where the scleral tissue begins to deteriorate. Although pain is often extreme in necrotizing anterior scleritis, a variant known as scleromalacia perforans can occur without pain, leading to a dangerously thinned sclera and possible exposure of the underlying choroid.

Posterior scleritis affects the sclera behind the insertion of the rectus muscles and is less commonly seen. Its signs may include choroidal folds, serous retinal detachments, or even optic nerve swelling. Because the inflammation in posterior scleritis is hidden behind ocular structures, it can pose a diagnostic challenge and is often associated with significant vision changes.

Early detection of scleritis is key to managing its progression and preventing complications. Here’s what you need to know about its clinical presentation:

A deep, boring, and often severe pain that may worsen with eye movement and can radiate to the surrounding areas of the face and head. This relentless pain is a distinguishing feature of scleritis.

Redness and Edema & Tenderness & Visual Disturbances & Systemic Symptoms & Risk Factors and Associated Conditions & Rheumatoid Arthritis & Lupus and Other Connective Tissue Diseases & Inflammatory Bowel Disease

The affected eye typically presents with a violet-bluish hue instead of a bright red, along with noticeable swelling of the scleral tissue.

The eye is unusually sensitive to touch, and even slight pressure may exacerbate the discomfort.

Symptoms may include blurred vision, tearing, and increased sensitivity to light. In severe cases, the inflammation can extend to adjacent ocular structures such as the cornea and uvea.

Since scleritis is often associated with systemic autoimmune diseases, patients might experience joint pain, skin nodules, weight loss, or symptoms related to conditions like lupus and rheumatoid arthritis.

When you experience persistent pain and redness in your eyes that do not improve with standard treatments, it is important to discuss these symptoms with our eye doctors, as they can help determine whether scleritis or another underlying condition is at play.

Understanding the risk factors for scleritis is crucial in identifying individuals who may be predisposed to developing this condition. Women are more commonly affected than men, and the condition most often appears in individuals between their fourth and sixth decades of life. In fact, up to 50% of scleritis patients may have an underlying systemic disease, making thorough laboratory workups and systemic evaluations an important component in the management strategy. This comprehensive approach allows our eye doctors to tailor treatment plans that address both the ocular inflammation and any systemic conditions. Beyond age and gender, several systemic conditions are frequently linked with scleritis:

One of the most common associations, rheumatoid arthritis is a key risk factor, with systemic vasculitis playing a role in the development of scleritis.

Autoimmune diseases such as systemic lupus erythematosus, Sjogren’s syndrome, and scleroderma can all manifest with scleritis as an ocular complication.

Conditions like ulcerative colitis and Crohn’s disease have also been linked to the occurrence of scleritis.

Infections and Trauma & Diagnosis and Clinical Evaluation & History and Symptom Evaluation & Visual Examination & Imaging Techniques & Laboratory Testing & Treatment Approaches to Manage Scleritis & Medical Therapy Options

Although less common, scleritis can be triggered by infections, surgical procedures, or even ocular trauma, particularly when there is an impaired conjunctival integrity.

  • History and Symptom Evaluation: A gradual onset of deep eye pain, often worsening at night and with eye movements, raises a red flag. Patients may also report systemic symptoms, making it necessary to consider associated autoimmune conditions.
  • Visual Examination: Through slit-lamp biomicroscopy, clinicians examine the eye under magnification to assess the depth and distribution of the inflamed vessels. Notably, blood vessels affected by scleritis do not blanch with the application of phenylephrine, a test that helps distinguish scleritis from more superficial conditions like episcleritis.
  • Imaging Techniques: For cases where posterior scleritis is suspected, advanced imaging such as B-scan ultrasonography or orbital magnetic resonance imaging (MRI) can be key to detecting scleral and choroidal thickening, nodules, or other internal changes.
  • Laboratory Testing: Blood tests, including a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and an array of autoantibody tests (e.g., antinuclear antibodies, rheumatoid factor, ANCA), are frequently used to look for systemic autoimmune conditions that may underlie the eye inflammation.

A careful differential diagnosis is vital since conditions like episcleritis and conjunctivitis can mimic some aspects of scleritis. Episcleritis, for example, usually involves only superficial inflammation without the severe pain or potential for vision loss associated with scleritis.

The initial management of scleritis typically involves the use of anti-inflammatory medications. Treatment is tailored to the severity and subtype of scleritis, and may include one or a combination of the following:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): For mild to moderate cases, oral NSAIDs such as indomethacin, ibuprofen, or flurbiprofen are usually the first line of treatment. These medications help alleviate pain and reduce inflammation. However, patients are advised about potential gastrointestinal and renal side effects, particularly if used over a long period.
  • Corticosteroids: When NSAIDs are insufficient or in cases of more severe or posterior scleritis, systemic corticosteroids such as prednisone are prescribed. Topical corticosteroids might also be used to manage localized inflammation; however, the systemic approach is often necessary given the depth of the inflammation. It is important for patients to understand the possible side effects of steroids, which can include increased intraocular pressure, weight gain, mood changes, and other systemic effects.
  • Immunomodulatory Agents: For patients who have a poor response to corticosteroids or who require long-term management to avoid steroid-related side effects, immunomodulatory medications may be recommended. Agents such as methotrexate, cyclosporine, and mycophenolate mofetil have been used effectively in managing scleritis associated with systemic autoimmune diseases. In recent years, tumor necrosis factor (TNF) alpha inhibitors have emerged as an option for refractory cases.

Treatment plans are carefully adjusted based on the patient’s clinical progress and laboratory markers. Regular follow-up appointments with our eye doctors ensure that any side effects of medications are promptly managed and that inflammation is accurately controlled.

If you’re experiencing persistent eye pain or redness, don’t wait any longer for relief. Contact one of the eye doctors listed with Specialty Vision today, and schedule a comprehensive evaluation to discuss scleritis treatment options tailored to your needs.

Surgical Intervention and Its Role & Monitoring and Follow-Up Care & Distinguishing Scleritis from Similar Eye Conditions & Challenges in Managing Scleritis and Coordinated Care & Potential Complications of Scleritis and Their Impact on Vision & Keratitis & Uveitis & Glaucoma

Although most cases of scleritis can be managed with medical therapies, surgical intervention may be necessary for complications:

  • Scleral Reinforcement: In cases where there is severe thinning of the sclera or imminent risk of perforation, a surgical graft using donor sclera, periosteum, or fascia lata might be required to provide structural support to the eye.
  • Biopsy Procedures: In rare cases, when there is uncertainty regarding the underlying cause of inflammation, a biopsy may be performed to exclude neoplastic or infectious causes. It is crucial that any such intervention is coordinated carefully to avoid compromising the already inflamed tissue.

Surgical decisions are made on a case-by-case basis, weighing the risk of further complications against the potential benefits, and are ideally performed once the active inflammatory process is under control.

One of the most important aspects of managing scleritis is ensuring that patients receive regular monitoring to track both the ocular condition and any associated systemic diseases. Our eye doctors work closely with other specialists such as rheumatologists and internists to provide a coordinated approach to care. Regular follow-up visits allow for adjustments in medication dosages, monitoring for potential side effects, and repeating laboratory tests to assess inflammatory markers.

  • Medications Adjustments: Based on the clinical response, medications like corticosteroids are tapered gradually to minimize side effects while sustaining remission of inflammation.
  • Laboratory Monitoring: Blood tests are essential to ensure that the immunomodulatory agents are not causing adverse systemic effects and that markers of inflammation are decreasing.
  • Imaging Follow-Up: In cases of posterior scleritis, follow-up imaging may be necessary to ensure that the thickness of the sclera and choroidal structures have returned to normal.

This ongoing collaborative management ensures that patients not only experience relief from pain but also maintain their vision over the long term.

One common challenge in eye care is to distinguish scleritis from conditions that may appear similar, such as episcleritis, conjunctivitis, or uveitis. Here’s how our eye doctors differentiate them:

  • Episcleritis: Inflammation in episcleritis is confined to the superficial episcleral tissue, causing mild discomfort and redness. In contrast, scleritis involves deeper ocular tissues, producing severe pain that is not relieved by simple topical treatments. A key test involves the use of phenylephrine eye drops; while the superficial vessels in episcleritis will blanch, the deeper inflamed vessels in scleritis remain unchanged.
  • Conjunctivitis: Often known as pink eye, conjunctivitis involves inflammation of the conjunctiva. Although it causes redness, it is typically associated with irritation or itchiness rather than the severe, boring pain found in scleritis. Conjunctivitis is more likely to be related to infections or allergies rather than systemic inflammatory diseases.
  • Uveitis: Inflammation of the uvea can share some symptoms, including blurred vision and photophobia (sensitivity to light). However, uveitis generally affects structures behind the sclera, and its management often involves a different treatment approach. Careful slit-lamp examination and additional imaging help delineate these conditions.

Accurate diagnosis is critical because the treatment protocols for these conditions differ significantly. A misdiagnosis may delay appropriate therapy, potentially risking vision loss.

The management of scleritis is often challenging due to its potential links to systemic diseases and the complexity of its presentation. Here’s the thing, early and aggressive treatment is vital to minimize tissue damage and preserve vision. Our eye doctors adopt a “hit them hard, hit them fast” approach, starting with potent anti-inflammatory therapies and then adjusting the regimen as the inflammation subsides.

This aggressive strategy helps to shorten the overall duration of the disease and reduces the risk of complications such as cataract formation, glaucoma, or permanent scleral thinning. In cases where scleritis is associated with an autoimmune disorder, a multidisciplinary approach involving rheumatologists is essential for both diagnosis and long-term management.

While many patients with mild or moderate scleritis maintain good vision with proper treatment, complications can occur if the inflammation is not adequately controlled. Regular monitoring and early intervention are key to identifying and managing these complications. Our eye doctors stress the importance of continuous follow-up appointments to ensure that any progression of the disease is swiftly addressed with appropriate adjustments in therapy. Some possible complications include:

Inflammation may extend to the cornea, leading to corneal thinning, peripheral ulceration, or scarring that compromises visual clarity.

The uveal tissues can become inflamed, resulting in additional pain and photophobia. Prolonged inflammation may also predispose the patient to secondary glaucoma.

Both the disease process and steroid use can contribute to elevated intraocular pressure, increasing the risk of optic nerve damage.

Scleral Thinning and Perforation & What to Expect During Your Visit & The Role of Systemic Medications and Ongoing Management & Empowering Patients Through Knowledge and Collaborative Care

Advanced cases, particularly necrotizing scleritis, can lead to significant thinning of the sclera. In severe instances, the integrity of the eyeball is compromised, potentially resulting in perforation and exposure of the inner ocular structures.

When you come in for an evaluation of scleritis, our eye doctors will take a detailed history and conduct a comprehensive eye examination to ascertain the extent and type of inflammation. They will ask about the onset, duration, and character of your pain, as well as any systemic symptoms that might point to an underlying autoimmune condition. Specialized imaging and laboratory tests are often part of this process, enabling a precise diagnosis and tailored treatment plan.

Your comfort and vision are our top priorities, and our team is dedicated to guiding you through each step of evaluation, treatment, and follow-up care.

The ideal management of scleritis goes beyond simply addressing the eye’s inflammation; it requires a long-term plan that considers the patient’s overall health. For many patients, systemic therapy is required not only to control eye inflammation but also to manage any associated autoimmune or inflammatory conditions. Medications such as corticosteroids, when used appropriately and tapered cautiously, can help control the inflammation quickly while minimizing side effects.

Immunomodulatory agents, though generally reserved for more severe cases or those resistant to steroid therapy, are an important tool in reducing the dependence on steroids in the long run. Our eye doctors work in tandem with your primary care physician or rheumatologist to formulate a treatment strategy that addresses your unique health profile.

This comprehensive approach is especially important given that scleritis can be a persistent or recurrent condition, sometimes lasting months or even years before entering remission. Through close coordination among various healthcare providers, we strive to achieve the best possible outcome for both your eye health and overall well-being.

Being diagnosed with scleritis can be overwhelming, but understanding the condition is the first step towards managing it effectively. Knowledge of the types, causes, and treatment options empowers patients to take an active role in their care. Our eye doctors are committed to providing you with clear, compassionate guidance every step of the way, from the initial diagnosis to long-term management and follow-up care.

It is always important to discuss any changes in your symptoms or concerns about your medications during your follow-up appointments. Open, respectful communication helps ensure that your individualized treatment plan evolves with your needs.

Scleritis: Symptoms, Risks, and Treatment Options for Eye Inflammation

If you’re experiencing persistent eye pain or redness, don’t wait any longer for relief. Contact one of the eye doctors listed with Specialty Vision today, and schedule a comprehensive evaluation to discuss scleritis treatment options tailored to your needs.

Common Questions

Scleritis is a serious inflammation of the sclera, the white part of the eye, which can cause severe pain and may lead to vision loss if not treated properly.
Common symptoms include severe eye pain, a distinctive violet-bluish color of the sclera, tenderness, and sometimes blurred vision or light sensitivity.
Treatment typically includes anti-inflammatory medications, corticosteroids, and may involve immunomodulatory agents for underlying autoimmune conditions.
Patients with systemic autoimmune diseases, such as rheumatoid arthritis or lupus, are at higher risk for developing scleritis, especially women in their 40s to 60s.
Complications can include keratitis, uveitis, glaucoma, scleral thinning, and in severe cases, the risk of perforation of the eye.
To accurately diagnose scleritis, eye doctors conduct a detailed symptom evaluation, visual examinations, and use imaging techniques like MRI to assess inflammation depth.
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Scleritis: Symptoms, Risks, and Treatment Options for Eye Inflammation

Scleritis is a serious eye condition requiring prompt treatment. Learn how to identify symptoms and find a top optometrist or ophthalmologist near you.

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