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Scleritis

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Updated January 31, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Scleritis is an inflammation of the sclera, the white outer covering of the eye. Scleritis can be destructive to the eye, causing intense pain and loss of vision for some people. Although sclerits may be associated with trauma or infection, more than half of scleritis cases are associated with an underlying systemic disease such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, polyarteritis nodosa, Wegener's granulomatosis, herpes zoster virus, gout and syphilis. It occurs most commonly between the ages of 30 and 60 years of age, and usually affects more women than men.

Scleritis Signs and Symptoms:

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 may become severe. Other symptoms include the following:
  • Eye pain that may involve the head and face
  • Tenderness
  • Light sensitivity
  • Tearing
  • Blurred or decreased vision
  • Eye redness (due to dilated blood vessels that may make the area appear darker red and take on a bluish hue.)

Types of Scleritis:

There are four types of scleritis:
  • Diffuse Scleritis: The most common type of scleritis, involving the front half of the sclera.
  • Nodular Scleritis: Small, tender nodules form on the sclera, representing generalized inflammation.
  • Necrotizing Scleritis: Also known as scleromalacia perforans, this type can be very serious and may result in loss of vision.
  • Posterior Scleritis: The rarest form of scleritis, involving the back part of the eye. May make the eye more susceptible to muscle problems, retinal detachment and angle closure glaucoma.

Diagnosis of Scleritis:

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

If left untreated, scleritis can lead to significant loss of vision. Scleritis is usually treated with oral anti-inflammatory medications. Immunosuppressive drugs are sometimes used. Scleritis does not usually respond well to topical eye drop medications. Some doctors prescribe topical steroids and non-steroidal anti-inflammatories. 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.

Source:

Catania, Louis. Primary Care of the Anterior Segment, 2nd Edition. Copyright 1995 by Appleton & Lange.

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