Scleritis is severe, destructive inflammation of the sclera (the tough, white, fiber layer covering the eye) that may threaten vision.
Scleritis sometimes occurs in people who have a bodywide inflammatory disease.
The main symptom is a deep, painful ache in the eye.
The diagnosis is based on symptoms and an examination of the eye.
Treatment typically begins with corticosteroids.
Scleritis is most common among women aged 30 to 50.
Scleritis may develop in people who also have a systemic rheumatic disease, such as rheumatoid arthritis, systemic lupus erythematosus, granulomatosis with polyangiitis, polyarteritis nodosa, or relapsing polychondritis, or another autoimmune disorder (a malfunction of the body's immune system that causes the body to attack its own tissues).
In a few people, scleritis is caused by an infection. About half of the cases of scleritis have no known cause.
An Inside Look at the Eye
Symptoms of Scleritis
Symptoms of scleritis typically include a deep, painful ache in the eye that is often constant and severe enough to interfere with sleep and reduce appetite. Other symptoms include eye tenderness, increased watering of the eye, and sensitivity to bright light. Redness that is purplish in color occurs over part or all of the eye.
RICHARD USATINE MD / SCIENCE PHOTO LIBRARY
Rarely, inflammation is severe enough to cause a hole to form in the eyeball (perforation) and loss of the eye. Such severe inflammation is called necrotizing scleritis. People who have necrotizing scleritis often have a systemic rheumatic disease.
Diagnosis of Scleritis
A doctor's evaluation of the symptoms and appearance of the eye
Sometimes imaging tests
Doctors diagnose scleritis based on the person's symptoms and on the appearance of the eye during a slit-lamp examination.
Rarely, doctors take a sample from the eye and test it if they suspect the person has an infection.
Sometimes the area of inflammation is in the back part of the eye (posterior scleritis), and an ultrasound or a computed tomography (CT) scan is needed to confirm the diagnosis of posterior scleritis.
Treatment of Scleritis
Corticosteroids
Sometimes other immunosuppressants
Sometimes surgical repair
To treat scleritis, doctors usually give low doses of corticosteroids taken by mouth (such as prednisone). Very rarely, nonsteroidal anti-inflammatory drugs (NSAIDs) taken by mouth are enough treatment for mild cases. If inflammation returns, doctors may give people corticosteroids to take for a longer period of time.To treat scleritis, doctors usually give low doses of corticosteroids taken by mouth (such as prednisone). Very rarely, nonsteroidal anti-inflammatory drugs (NSAIDs) taken by mouth are enough treatment for mild cases. If inflammation returns, doctors may give people corticosteroids to take for a longer period of time.
If people need more than low doses of corticosteroids or have necrotizing scleritis and a systemic rheumatic disease, doctors give a medication that suppresses the immune system (immunosuppressant), such as methotrexate, cyclophosphamide, or rituximab.If people need more than low doses of corticosteroids or have necrotizing scleritis and a systemic rheumatic disease, doctors give a medication that suppresses the immune system (immunosuppressant), such as methotrexate, cyclophosphamide, or rituximab.
People who are at risk of a perforation may need surgical repair.
Prognosis for Scleritis
Some people who have scleritis lose some of their sharpness of vision.
