Scleritis
What Is Scleritis?
Scleritis involves inflammation of the sclera, the tough outer layer that protects the eye. It can be very painful and may signal other health issues, so learning about it empowers you to take better care of your eyes.
Scleritis can present in several forms based on the area of the eye affected and its severity. Knowing your type helps your doctor choose the right treatment.
- Diffuse anterior: Widespread inflammation over most of the front of the sclera, causing redness and pain.
- Nodular anterior: Firm, raised, painful bumps on the sclera.
- Necrotizing anterior: A severe form that can thin the sclera and threaten the eye's integrity.
- Posterior: Inflammation at the back of the eye that can cause vision changes, sometimes without much visible redness.
Scleritis is rare, affecting about 3 to 4 people per 100,000 each year. It most often appears in adults between the ages of 40 and 60 and is slightly more common in women, which may be due to higher rates of autoimmune diseases.
The sclera is the tough, protective outer layer that maintains your eye's shape and shields its delicate inner parts from injury. When the sclera is inflamed, its protective function is weakened, which can lead to discomfort and serious complications if left untreated.
Causes and Risk Factors
Scleritis often stems from underlying health issues, such as autoimmune diseases, or less commonly from infections that trigger inflammation in the eye. Identifying these causes can help manage the condition more effectively.
Many cases of scleritis are linked to autoimmune disorders, where the body's immune system mistakenly attacks its own healthy tissues. Conditions like rheumatoid arthritis, lupus, granulomatosis with polyangiitis, and inflammatory bowel disease are common causes.
Infections from bacteria, viruses, fungi, or parasites can sometimes trigger scleritis, especially after an eye injury, surgery, or a corneal ulcer. Treating infections quickly is important to reduce this risk.
In rare cases, certain medications, severe allergic reactions, or eye injuries can lead to scleritis. A history of eye surgery or exposure to irritants like chemicals may also play a role.
Some factors can increase your chance of getting scleritis. Watching for these can help with early detection and management.
- Having an autoimmune disease.
- Being middle-aged, especially between 40 to 60 years old.
- Smoking or having poor overall health, which can worsen inflammation.
- A family history of inflammatory or autoimmune conditions.
Symptoms of Scleritis
The main signs of scleritis are deep eye pain and redness that do not go away easily. Early recognition of symptoms allows for faster relief and better outcomes.
One of the main symptoms is a severe, deep, aching pain in the eye that can spread to your head, face, or jaw. The eye often looks very red or purplish, and you may experience blurred vision or sensitivity to light.
Pain may become stronger with eye movement or at night, making it hard to sleep or focus. In severe cases, the eye may swell or change shape. If pain persists despite over-the-counter medication, it is a strong signal to see a doctor.
Unlike the gritty, itchy feeling of pink eye (conjunctivitis), scleritis causes a deep, constant pain. And unlike episcleritis, which is a milder inflammation, scleritis can threaten your vision if it is not treated.
When scleritis is connected to an autoimmune condition, it may be accompanied by symptoms like joint pain, fatigue, fever, or skin rashes. Reporting these symptoms to your doctor is important for a comprehensive diagnosis and treatment plan.
Diagnosis and Tests
To diagnose scleritis, an eye doctor will perform a thorough eye exam and may order additional tests. These steps ensure you get an accurate diagnosis and the correct treatment plan.
During an exam, your doctor will use a slit lamp, which is a special microscope with a bright light, to look closely at your sclera. They will check for signs of inflammation and ask about your health history and symptoms to distinguish scleritis from other conditions.
Blood tests are often used to check for autoimmune conditions or infections that could be causing the scleritis. Other tests may also be needed.
- Imaging, like an ultrasound or CT scan, helps your doctor check the deeper parts of your eye, especially for posterior scleritis.
- A biopsy, which involves taking a small tissue sample, is rare but may be done to identify specific infections or other unusual causes.
- Vision tests will track any changes in your sight over time.
You may need more than one visit to confirm the diagnosis, especially if a systemic disease is suspected. Your eye doctor may also work with other specialists, like a rheumatologist, as part of your overall care.
Treatment Options
Treatment for scleritis focuses on reducing inflammation, relieving pain, and addressing any underlying illness. The specific plan will depend on how severe your scleritis is and what is causing it.
Over-the-counter anti-inflammatory drugs like ibuprofen may help in very mild cases. More often, stronger medications like corticosteroids in pill form or as injections are needed to control the inflammation.
For severe cases, especially those linked to an autoimmune disease, newer drugs called biologics can be used to calm the immune system. If the sclera becomes very thin and is at risk of tearing, surgery may be needed to repair and strengthen it.
While following your doctor’s treatment plan is most important, you can also take steps at home to help your recovery and manage discomfort.
- Use cold compresses on your eyes for comfort.
- Limit screen time and rest your eyes when they feel strained.
- Wear sunglasses outdoors to protect your eyes from bright light and wind.
- Take all your medications exactly as your doctor prescribed.
FAQs About Scleritis
Here are answers to common questions about scleritis to help you feel more informed. Understanding your condition can help you have more productive discussions with your eye care team.
Scleritis almost never goes away on its own and requires medical treatment. Because it is often caused by an underlying health issue, leaving it untreated can lead to serious complications, including vision loss.
No, you cannot catch scleritis from someone else. It is an inflammatory condition linked to your own body's immune system or an infection, not person-to-person spread.
Treatment time depends on the severity and cause of the scleritis. Mild cases may improve in a few weeks, but cases linked to autoimmune diseases may require ongoing treatment for many months or even years to control flare-ups.
While not all cases can be prevented, healthy habits can support your overall immune health and may lower your risk. This includes eating a balanced diet, not smoking, managing stress, and treating any existing systemic diseases.
If left untreated, severe scleritis can damage the sclera and other parts of the eye, which can lead to permanent vision loss. Prompt and effective treatment greatly reduces this risk.
Episcleritis is a milder inflammation of the thin tissue layer over the sclera that often looks red but causes less pain and usually clears up on its own. Scleritis is a deeper, much more painful inflammation that can threaten vision and requires medical treatment.
About half of all scleritis cases are linked to an autoimmune disease. If no underlying condition is found at first, your doctor will still monitor you, as systemic symptoms can sometimes appear later.
In rare instances, eye surgery can trigger scleritis due to trauma, an immune response, or a postoperative infection. It is important to let your ophthalmologist know if you have a history of scleritis or autoimmune disease before any surgery.
No, they are different conditions. Scleritis is inflammation of the eye's outer white layer (the sclera), while uveitis is inflammation of the middle layer of the eye (the uvea). Though different, they can sometimes occur at the same time.
Stress itself does not cause scleritis, but it can worsen autoimmune diseases that may trigger a scleritis flare-up. Managing stress can help regulate the immune system and may reduce the frequency of flare-ups.
You should go to the emergency room if you experience a sudden change or loss of vision, severe eye pain that doesn't get better, or if you notice the white of your eye looking thin or bluish. These are signs of severe scleritis that needs immediate attention.
Scleritis is very rare in children but can happen, especially if the child has an autoimmune disorder. It requires specialized care to protect their vision as their eyes are still developing.
Taking Care of Your Eyes
If you have symptoms of scleritis, such as deep eye pain and redness, schedule an eye exam right away. With a timely diagnosis and the right treatment plan, most people can recover well and maintain healthy eyes for the long term.