Scleritis

What Is It?

Scleritis is a potentially serious inflammation of the sclera, the tough, white tissue that covers about four-fifths of the outer eye. (The front fifth, the clear cornea, is where light passes through the eye, enabling us to see.) Over 50 percent of cases of scleritis are associated with another disease that affects the whole body, such as rheumatoid arthritis, or are a result of infection or injury. Scleritis occurs most often in people aged 30 to 60 and is rare in children. If left untreated, the condition can spread to surrounding structures in the eye and may damage the eye itself, including causing changes in vision.

Pain and redness of the sclera are the two distinguishing symptoms of scleritis. These symptoms usually develop gradually, and eventually become severe. The redness may become an intense purple. Many people with scleritis have pain radiating from the eye to adjacent areas of the head and face. Less commonly, the eye becomes teary and very sensitive to light. There also can be loss of vision.

Your eye doctor will take a complete history and conduct a thorough examination. Scleritis needs to be distinguished from a less dangerous condition called episcleritis, in which the covering of the sclera is inflamed. In addition, because of the association between scleritis and other conditions, your doctor may suggest a comprehensive medical examination, including blood counts and other tests and evaluations. Ultrasound, computed tomography (CT) scanning, magnetic resonance imaging (MRI) or a biopsy may be used to rule out other causes of symptoms.

Depending on its cause, scleritis should begin to clear up fairly quickly once treatment begins.

Scleritis cannot be prevented because the cause is unknown for most cases of scleritis and the diseases with which it is associated.

Scleritis usually is treated with both a topical eye solution and an oral medication containing corticosteroids. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others) may be used for pain relief. Occasionally, more powerful medications that suppress the immune system may be prescribed. If infection is the cause, your treatment will include antimicrobial medications. In severe cases, surgery may be required to repair injured areas of the eyeball.

You should call your doctor immediately if your eye is painful and red.

Scleritis usually responds to treatment, but the condition may recur. If left untreated, scleritis can lead to perforation of the eyeball.

The long-term prognosis largely depends on what caused the condition. Complications are common and can include keratitis (inflammation of the cornea), cataracts (scarring of the lens), uveitis (inflammation of the eye behind the pupil), and glaucoma (elevated pressure in the eye that may lead to vision loss).

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