Scleritis is a severe inflammation of the white part of the eye
Scleritis is an uncommon inflammation of the sclera, the white layer of the eye. It is common in patients that have an underlying autoimmune disease (e.g. rheumatoid arthritis) or other disease process. Scleritis typically occurs in patients 30-60 years old and is rare in children. Scleritis must be differentiated from episcleritis, a much less severe inflammation that affects the episclera.
Causes of Scleritis
In 50% of patients, scleritis is associated with an underlying systemic disease process. Common associated systemic diseases include autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel syndrome, etc), herpes zoster (shingles), syphilis and gout. Scleritis can also be idiopathic (have an unknown cause) in some cases.
Signs and Symptoms of Scleritis
Common symptoms of scleritis include:
- Gradual onset of pain leading to fairly severe eye pain that may spread to the surrounding head
- Light sensitivity
- Redness on the white part of the eye. Can involve a small sector or the entire white of the eye.
- Decrease in vision
- If the posterior part of the eye is involved, there can be double vision and/or pain upon eye movement
- Recurrent/chronic symptoms in patients with underlying systemic disease
Common signs of scleritis include:
- Inflammation (swelling) of the sclera, episclera, and overlying conjunctival blood vessels
- Red patches do not blanch (whiten) with topical phenylephrine (decongestant eye drop)
- Thinning of the sclera (white layer appears blue because underlying tissue, the choroid becomes visible)
Treatment/Prognosis of Sclertitis
If these symptoms are experienced, the patient should have a complete eye exam including dilation to rule out other disorders. Underlying systemic disease is the cause in about 50% of cases so a physical exam with their primary care physician including a blood work-up for auto-immune disease. Treatment may include oral non-steroidal anti-inflammatory (NSAIDs), oral corticosteroids, and/or oral immunosuppressive therapy. If the scleritis and underlying disease are not treated promptly, the inflammation can spread to other parts of the eye. Also, symptoms can recur and more serious complications can develop (perforation of the globe). Length of treatment and follow up will depend on the severity of the signs and symptoms.
Scleritis can worsen and progress to ischemia and necrosis, which may lead to scleral thinning and perforation of the globe and possibly lead to blindness.