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Scleritis sklə-ˈrīt-əs

By Melvin I. Roat, MD, FACS

Scleritis is a deep, extremely painful inflammation and purple discoloration of the sclera (the tough white fiber layer covering the eye) that may severely damage vision.

Scleritis is most common among women aged 30 to 50. In one third of cases, it affects both eyes. Scleritis may accompany rheumatoid arthritis, systemic lupus erythematosus, or another autoimmune disorder. About half of the cases of scleritis have no known cause.

Symptoms include pain in the eye (typically a deep ache) that often interferes with sleep and reduces appetite. Other symptoms include eye tenderness, increased watering of the eye, and sensitivity to bright light. Redness occurs over part or all of the eye. Rarely, inflammation is severe enough to cause perforation of the eyeball and loss of the eye.

Doctors diagnose scleritis by its symptoms and appearance during a slit-lamp examination (see page The Eye Examination : Slit-Lamp Examination). Sometimes the area of inflammation is in the back part of the eye (posterior scleritis), and an ultrasound or computed tomography (CT) scan is needed to confirm the diagnosis.

Doctors usually give corticosteroids taken by mouth (such as prednisone). Very rarely, nonsteroidal anti-inflammatory drugs taken by mouth are enough treatment for mild cases. If the person has an autoimmune disorder (a malfunction of the body's immune system that causes the body to attack its own tissues) such as rheumatoid arthritis or does not respond to corticosteroids, drugs that suppress the immune system, such as cyclophosphamide or azathioprine, may be needed.

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