Scleritis Types, Symptoms, and Diagnosis

Scleritis is a rare inflammation of the sclera, the white outer covering of the eye, which is made of collagen. Blood vessels travel through and on top of the sclera and can be involved in scleritis.

The main cause of scleritis is usually an autoimmune disorder or unknown. If left untreated, scleritis can be sight threatening, meaning it can cause vision loss. Scleritis is considered serious and may require emergency care.

This article provides an overview of scleritis and discusses symptoms, types, and causes of scleritis. It talks about how scleritis is diagnosed, which treatments are available, and what you can do to prevent scleritis.

Overview of Scleritis

Scleritis can be destructive to the eye, causing intense pain and loss of vision for some people. Although scleritis may be associated with trauma or infection, more than half of scleritis cases are associated with an underlying systemic disease. Possibly underlying systemic diseases include:

• Rheumatoid arthritis
• Ankylosing spondylitis
• Systemic lupus erythematosus
• Polyarteritis nodosa
• Granulomatosis with polyangiitis
• Herpes zoster virus
• Gout
• Syphilis

Scleritis is thought to be a sign of inflammation that may be present elsewhere in the body. It usually affects middle-aged people, and women are more affected than men.

This condition is serious and may require emergency care. Usually an ophthalmologist will be the one treating the condition.

Symptoms of Scleritis

Scleritis usually develops in one eye but may affect both eyes together. The main symptoms of scleritis are pain and redness in the white part of the eye that sometimes becomes severe.

Scleritis may appear with these symptoms:

• Severe pain
• Tenderness of the eye
• Inflammation of the white part of the eye (sclera)
• Extreme light sensitivity
• Tearing
• Blurred or decreased vision

Some people with scleritis also have pain of the jaw, face, or head on the same side as the affected eye. Partial or complete loss of vision may occur.

Types of Scleritis

There are two main types of scleritis—anterior (the front) and posterior (the back)—depending on what part of the eye is affected.

Anterior Scleritis

Anterior scleritis is more common than posterior scleritis.

It can be further divided into the following three types:

• Diffuse scleritis: The most common type of scleritis, it involves the front half of the sclera. About 60% of anterior scleritis cases fall into this category.
• Nodular scleritis: Small, tender nodules form on the sclera, representing generalized inflammation. It is the second most common form of anterior scleritis, comprising 40% of cases.
• Necrotizing scleritis: Also known as scleromalacia perforans, this type can be very serious and may result in loss of vision. This type is more frequently seen in older patients.

Posterior Scleritis

Posterior scleritis is the rarest form of scleritis. It can be a much more severe form of the disease and is sometimes difficult to diagnose. Since this form occurs in the back of the eye, the eye may still look white.

This type may make the eye more susceptible to retinal detachment and angle-closure glaucoma.

Causes of Scleritis

Many causes of scleritis are idiopathic (occurring for an unknown reason). Healthcare providers never find a direct cause. Scleritis seems to be most often associated with these conditions:

• Different forms of arthritis
• Eye infection
• Lupus
• Connective tissue disease
• Inflammatory bowel disease
• Sjogren's syndrome
• Granulomatosis
• Scleroderma

Other causes of scleritis include trauma (injury) to the eye and, rarely, a fungus or parasite.

Scleritis Diagnosis

Healthcare providers diagnose scleritis by evaluating your medical history. You will be given tests to measure your visual acuity and intraocular pressure. Your healthcare provider will examine your eyes by using a slit lamp biomicroscope. Also, your eyes will be dilated to examine the inside of your eyes.

Your healthcare provider may use certain eye drops to help distinguish between scleritis and episcleritis, a condition that may also be associated with autoimmune disorders but involves the tissue and vessels in the tissue between the sclera and the conjunctiva.

Treatment for Scleritis

If left untreated, scleritis can lead to significant loss of vision. Scleritis is usually treated with oral anti-inflammatory medications, such as ibuprofen or prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs).

Oral steroids are often prescribed, as well as a direct injection of steroids into the tissue itself. Immunosuppressive drugs are sometimes used.

Scleritis does not usually respond well to topical eye drop medication, however, so some healthcare providers prescribe topical steroids and NSAIDs. Note, however, that application of topical corticosteroids may make necrotizing scleritis worse.

Treatment of associated problems with scleritis, such as glaucoma, may also be required. Because many cases of scleritis are associated with an underlying systemic disease, treatment is centered around treating that disease to stop the progression of scleritis.

Prevention of Scleritis

Because scleritis is a condition that usually develops due to an underlying inflammation in the eye, most healthy individuals do not have to worry about developing scleritis. However, if you have an autoimmune disorder, healthcare providers recommend you try the following to avoid scleritis:

• Pay attention to the systemic condition you may have that could predispose you to developing scleritis. Keep your healthcare provider visits and take your medication. Even though you may feel fine, you could have inflammation developing silently.
• Stay out of the wind and air. Although this is more common in episcleritis (an inflammation affecting the episcleral tissue causing red eye), some cases of scleritis have developed from external exposure such as constant wind and sun.
• Eat healthily and take a multivitamin. Medical journals have reported cases of scleritis that were thought to be caused by a lack of certain vitamins, such as vitamin D.

Summary

Scleritis is a rare inflammation of the white part of the eye (sclera). Its symptoms include pain and tenderness. There are two general types of scleritis. Anterior scleritis affects the front part of the eye, while posterior scleritis affects the back.

The cause of scleritis is usually an autoimmune disease or is unknown. Without treatment, scleritis can cause loss of vision. Talk to a healthcare provider or eye specialist if you are experiencing pain in your eye or changes in vision to get the the proper treatment for your condition.